Prognostic risk stratification of myocardial ischaemia evaluated by gated myocardial perfusion SPECT in patients with chronic kidney disease

  • Tsuguru Hatta
  • Shigeyuki Nishimura
  • Tsunehiko Nishimura
Original Article



The aim of this study was to identify useful predictors of cardiac events in patients with chronic kidney disease (CKD).


Among 4,031 patients identified from the Japanese Assessment of Cardiac Events and Survival Study (J-ACCESS) database with suspected or known ischaemic heart disease, we selected 820 with an estimated glomerular filtration rate (eGFR) of < 60 ml/min per 1.73 m2.


A total of 75 cardiac events developed among these 820 patients. The incidence of cardiac events was higher in the group with a lower eGFR. Multivariate Cox analysis indicated that age, diabetes mellitus, end-systolic volume, summed stress score (SSS) and eGFR were predictors of cardiac events. Event rates of patients with SSS ≥ 9 were significantly higher in groups with lower eGFR values (< 40 and 40–49 ml/min).


The SSS value (≥ 9) is a reliable predictor of cardiac events and myocardial single photon emission computed tomography has incremental value for predicting cardiac events and survival in CKD.


Cardiovascular event Proteinuria Cardiorenal syndrome 



We appreciate the cooperation of the many physicians and technologists at all of the hospitals that participated in the J-ACCESS study. A list of participating institutions and physicians appears elsewhere [16]. We also thank the staff of the J-ACCESS office for performing this study, which was supported by grants from the Japan Cardiovascular Research Foundation. None of the authors have any conflicts of interest related to this study.


  1. 1.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–305. doi: 10.1056/NEJMoa041031.CrossRefPubMedGoogle Scholar
  2. 2.
    Guyton AC. Blood pressure control–special role of the kidneys and body fluids. Science 1991;252:1813–6. doi: 10.1126/science.2063193.CrossRefPubMedGoogle Scholar
  3. 3.
    Bongartz LG, Cramer MJ, Braam B. The cardiorenal connection. Hypertension 2004;43:e14. doi: 10.1161/01.HYP.0000118521.06245.b8.CrossRefPubMedGoogle Scholar
  4. 4.
    Hakeem A, Bhatti S, Dillie KS, Cook JR, Samad Z, Roth-Cline MD, et al. Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function on cardiac death. Circulation 2008;118:2540–9. doi: 10.1161/CIRCULATIONAHA.108.788109.CrossRefPubMedGoogle Scholar
  5. 5.
    Nishimura T, Nakajima K, Kusuoka H, Yamashina A, Nishimura S. Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study. Eur J Nucl Med Mol Imaging 2008;35:319–28. doi: 10.1007/s00259-007-0608-x.CrossRefPubMedGoogle Scholar
  6. 6.
    Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535–43.PubMedGoogle Scholar
  7. 7.
    Bergeron S, Hillis GS, Haugen EN, Oh JK, Bailey KR, Pellikka PA. Prognostic value of dobutamine stress echocardiography in patients with chronic kidney disease. Am Heart J 2007;153:385–91. doi: 10.1016/j.ahj.2006.11.012.CrossRefPubMedGoogle Scholar
  8. 8.
    Cook JR, Dillie KS, Hakeem A, Bhatti S, Chang SM. Effectiveness of anemia and chronic kidney disease as predictors for presence and severity of coronary artery disease in patients undergoing stress myocardial perfusion study. Am J Cardiol 2008;102:266–71. doi: 10.1016/j.amjcard.2008.03.045.CrossRefPubMedGoogle Scholar
  9. 9.
    Hase H, Joki N, Ishikawa H, Fukuda H, Imamura Y, Saijyo T, et al. Prognostic value of stress myocardial perfusion imaging using adenosine triphosphate at the beginning of haemodialysis treatment in patients with end-stage renal disease. Nephrol Dial Transplant 2004;19:1161–7. doi: 10.1093/ndt/gfh037.CrossRefPubMedGoogle Scholar
  10. 10.
    Dahan M, Viron BM, Faraggi M, Himbert DL, Legallicier BJ, Kolta AM, et al. Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients. Kidney Int 1998;54:255–62. doi: 10.1046/j.1523-1755.1998.00988.x.CrossRefPubMedGoogle Scholar
  11. 11.
    Wong CF, Little S, Vinjamuri S, Hammad A, Harper JM. Technetium myocardial perfusion scanning in prerenal transplant evaluation in the United Kingdom. Transplant Proc 2008;40:1324–8. doi: 10.1016/j.transproceed.2008.03.143.CrossRefPubMedGoogle Scholar
  12. 12.
    de Mattos AM, Siedlecki A, Gaston RS, Perry GJ, Julian BA, Kew CE 2nd, et al. Systolic dysfunction portends increased mortality among those waiting for renal transplant. J Am Soc Nephrol 2008;19:1191–6. doi: 10.1681/ASN.2007040503.CrossRefPubMedGoogle Scholar
  13. 13.
    Hage FG, Smalheiser S, Zoghbi GJ, Perry GJ, Deierhoi M, Warnock D, et al. Predictors of survival in patients with end-stage renal disease evaluated for kidney transplantation. Am J Cardiol 2007;100:1020–5. doi: 10.1016/j.amjcard.2007.04.045.CrossRefPubMedGoogle Scholar
  14. 14.
    Venkataraman R, Hage FG, Dorfman T, Heo J, Aqel RA, de Mattos AM, et al. Role of myocardial perfusion imaging in patients with end-stage renal disease undergoing coronary angiography. Am J Cardiol 2008;102:1451–6. doi: 10.1016/j.amjcard.2008.07.029.CrossRefPubMedGoogle Scholar
  15. 15.
    Reddan DN, Szczech LA, Tuttle RH, Shaw LK, Jones RH, Schwab SJ, et al. Chronic kidney disease, mortality, and treatment strategies among patients with clinically significant coronary artery disease. J Am Soc Nephrol 2003;14:2373–80. doi: 10.1097/01.ASN.0000083900.92829.F5.CrossRefPubMedGoogle Scholar
  16. 16.
    Kusuoka H, Nishimura S, Yamashina A, Nakajima K, Nishimura T. Surveillance study for creating the national clinical database related to ECG-gated myocardial perfusion SPECT of ischemic heart disease: J-ACCESS study design. Ann Nucl Med 2006;20:195–202. doi: 10.1007/BF03027430.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Tsuguru Hatta
    • 1
  • Shigeyuki Nishimura
    • 2
  • Tsunehiko Nishimura
    • 3
  1. 1.Division of Nephrology, Department of MedicineOhmihachiman Community Medical CenterShigaJapan
  2. 2.Division of CardiologySaitama Medical School HospitalSaitamaJapan
  3. 3.Department of Radiology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan

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