Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation

  • Nobuhiko Joki
  • Hiroki Hase
  • Yuhei Kawano
  • Satoko Nakamura
  • Kenichi Nakajima
  • Tsuguru Hatta
  • Shigeyuki Nishimura
  • Masao Moroi
  • Susumu Nakagawa
  • Tokuo Kasai
  • Hideo Kusuoka
  • Yasuchika Takeishi
  • Mitsuru Momose
  • Kazuya Takehana
  • Mamoru Nanasato
  • Shunichi Yoda
  • Hidetaka Nishina
  • Naoya Matsumoto
  • Tsunehiko Nishimura
Original Article

DOI: 10.1007/s00259-014-2781-z

Cite this article as:
Joki, N., Hase, H., Kawano, Y. et al. Eur J Nucl Med Mol Imaging (2014) 41: 1701. doi:10.1007/s00259-014-2781-z

Abstract

Purpose

Whether myocardial perfusion imaging (MPI) can predict cardiac events in patients with advanced conservative chronic kidney disease (CKD) remains unclear.

Methods

The present multicenter prospective cohort study aimed to clarify the ability of MPI to predict cardiac events in 529 patients with CKD and estimated glomerular filtration rates (eGFR) < 50 ml/min per 1.732 without a definitive diagnosis of coronary artery disease. All patients were assessed by stress-rest MPI with 99mTc-tetrofosmin and analyzed using summed defect scores and QGS software. Cardiac events were analyzed 1 year after registration.

Results

Myocardial perfusion abnormalities defined as summed stress score (SSS) ≥4 and ≥8 were identified in 19 and 7 % of patients, respectively. At the end of the 1-year follow-up, 33 (6.2 %) cardiac events had occurred that included cardiac death, sudden death, nonfatal myocardial infarction, and hospitalization due to heart failure. The event-free rates at that time were 0.95, 0.90, and 0.81 for groups with SSS 0–3, 4–7, and ≥8, respectively (p = 0.0009). Thus, patients with abnormal SSS had a higher incidence of cardiac events. Multivariate Cox regression analysis showed that SSS significantly impacts the prediction of cardiac events independently of eGFR and left ventricular ejection fraction.

Conclusion

MPI would be useful to stratify patients with advanced conservative CKD who are at high risk of cardiac events without adversely affecting damaged kidneys.

Keywords

Coronary artery disease99mTc-TetrofosminMulticenter studyHemoglobinChronic kidney disease

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Nobuhiko Joki
    • 1
  • Hiroki Hase
    • 1
  • Yuhei Kawano
    • 2
  • Satoko Nakamura
    • 2
  • Kenichi Nakajima
    • 3
  • Tsuguru Hatta
    • 4
  • Shigeyuki Nishimura
    • 5
  • Masao Moroi
    • 6
  • Susumu Nakagawa
    • 7
  • Tokuo Kasai
    • 8
  • Hideo Kusuoka
    • 9
  • Yasuchika Takeishi
    • 10
  • Mitsuru Momose
    • 11
  • Kazuya Takehana
    • 12
  • Mamoru Nanasato
    • 13
  • Shunichi Yoda
    • 14
  • Hidetaka Nishina
    • 15
  • Naoya Matsumoto
    • 16
  • Tsunehiko Nishimura
    • 17
  1. 1.Department of NephrologyToho University Ohashi Medical CenterTokyoJapan
  2. 2.Division of Hypertension and NephrologyNational Cerebral and Cardiovascular CenterOsakaJapan
  3. 3.Department of Nuclear MedicineKanazawa University HospitalKanazawaJapan
  4. 4.Hatta Medical Office of Internal MedicineKyotoJapan
  5. 5.Saitama Medical University International Medical CenterSaitamaJapan
  6. 6.Department of CardiologyToho University Ohashi Medical CenterTokyoJapan
  7. 7.Department of CardiologySaiseikai Central HospitalTokyoJapan
  8. 8.Tokyo Medical University Hachioji Medical CenterTokyoJapan
  9. 9.Osaka National HospitalOsakaJapan
  10. 10.Department of Cardiology and HematologyFukushima Medical UniversityFukushimaJapan
  11. 11.Department of Diagnostic Imaging and Nuclear MedicineTokyo Women’s Medical UniversityTokyoJapan
  12. 12.Department of CardiologyKansai Medical UniversityOsakaJapan
  13. 13.Nagoya Daini Red Cross HospitalCardiovascular CenterNagoyaJapan
  14. 14.Department of CardiologyNihon University Itabashi HospitalTokyoJapan
  15. 15.Department of CardiologyTsukuba Medical Center HospitalTsukubaJapan
  16. 16.Department of CardiologySuruga-dai Nihon University HospitalTokyoJapan
  17. 17.Kyoto Prefectural University of MedicineKamigyo-kuJapan