Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation

Abstract

Abstract. The prognostic utility of myocardial perfusion studies (MPS) such as thallium scintigraphy and dobutamine stress echocardiography (DSE) for stratifying cardiac risk among candidates for kidney or kidney-pancreas transplantation is uncertain. This study is a meta-analysis to determine the prognostic significance of MPS results on future myocardial infarction (MI) and cardiac death (CD) in patients with end-stage renal disease (ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was searched using combinations of MeSH headings and text words for transplantation, coronary artery disease, prognosis, end-stage renal disease, and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary studies. Studies were included if they reported MPS results and cardiac events in patients assessed for kidney or kidney-pancreas transplantation. Methodologic study quality and outcome data were independently abstracted in duplicate by two researchers. The relative risks (RR) of MI and CD were calculated using a random effects model. Twelve articles met all inclusion criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium scintigraphy was used (four with pharmacologic stress, four with exercise stress), whereas four used DSE. When compared with negative tests, positive tests had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P ϭ 0.01) and CD (2.92 [95% CI, 1.66 to 5.12]; P Ͻ 0.001). Subgroup analyses of studies of diabetic patients indicated that positive tests were associated with a RR of CD 3.95 (95% CI, 1.48 to 10.5; P ϭ 0.006) and a RR of MI 2.68 (95% CI, 0.95 to 7.57; P ϭ 0.06) when compared with negative tests. In studies evaluating mixed populations of diabetic and nondiabetic patients, positive tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P ϭ 0.01) and with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P ϭ 0.09) when compared with a negative test. The presence of reversible defects was associated with an increased risk of MI in diabetic patients and of CD in both subgroups; fixed defects were associated with an increased risk of CD but not MI. It is concluded that positive MPS are useful in identifying patients with significantly increased risk of future MI and CD in both diabetic and nondiabetic ESRD patients. Cardiovascular disease is common in individuals with endstage renal disease (ESRD) and accounts for between 40 and 45% of all deaths in these patients (1,2). At the time of initiation of chronic dialysis treatment in 1999, approximately 25% of patients have a history of ischemic heart disease and about 10% have had myocardial infarction (MI) (2,3). Although the rate of death from cardiac disease in ESRD patients in the United States fell in the 8-yr period between 1991 and 1998, the incident rate of MI rose in the second and third years of treatment by 15.7% and 6.8%, respectively (4). In addition, the short-term and long-term prognosis after acute MI in ESRD patients is poor, with 40% of patients dying of cardiac causes at ...

Kidney Disease as a Risk Factor for Development of Cardiovascular Disease

“…A recent meta-analysis reveals that stress imaging is of value in predicting CVD morbidity and mortality in kidney transplantation candidates treated by dialysis. 32 It remains unknown, however, whether the diagnostic accuracy of these tests, as defined by a "gold standard" of angiographic obstructive coronary artery disease, is different from the general population. Furthermore, it remains unknown whether stress nuclear or stress echocardiographic testing is more accurate in patients with CKD.…”

Predictive Value of Myocardial Perfusion Single-Photon Emission Computed Tomography and the Impact of Renal Function on Cardiac Death

“…[2][3][4] Studies evaluating the prognostic value of MPS have not included renal dysfunction in their analyses 20 or have only included patients with end-stage renal disease who are renal transplant candidates. [21][22][23] Hence, our objectives were severalfold: (1) to study the prognostic value of myocardial perfusion abnormalities on single-photon emission CT (SPECT) in the risk stratification of patients with varying degrees of renal dysfunction; (2) to study the impact of renal dysfunction on cardiovascular outcomes in patients undergoing MPS for evaluation of CAD; and (3) to determine whether renal dysfunction (estimated glomerular filtration rate [eGFR] Ͻ60 mL · min Ϫ1 · 1.73 m Ϫ2 ) combined with myocardial perfusion abnormalities on MPS (summed stress score [SSS]) provides additional prognostic information superior to either marker alone.…”

Cardiac Findings in Asymptomatic Chronic Hemodialysis Patients with Persistently Elevated Cardiac Troponin I Levels

“…We wondered whether this finding might indicate the presence of coronary artery disease with silent myocardial ischemia, and therefore decided to investigate these patients further using a test capable of detecting the presence of an ongoing reversible myocardial ischemia such as dipyridamoleexercise (D-E) thallium scintigraphy. [10][11][12] In a previous study involving asymptomatic HD patients, D-E thallium scintigraphy showed a sensitivity of 92% and a specificity of 89% in detecting significant coronary lesions compared with coronary angiography. [11] Data are mean ± SD.…”