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Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

  • Cardiac Nuclear Imaging (A Cuocolo and M Petretta, Section Editors)
  • Published:
Current Cardiovascular Imaging Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Patients with end-stage renal disease (ESRD) have an increased risk of cardiovascular morbidity and mortality. Cardiac risk assessment, though challenging, is critical in these high-risk patients, particularly in the pre-transplant population. In this review, we discuss the burden of coronary artery disease in the ESRD population and review the literature on the diagnostic and prognostic performance, clinical value, and future directions of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in ESRD patients.

Recent Findings

Stress myocardial perfusion imaging provides incremental prognostic value to clinical data. The American Heart Association/American College of Cardiology Foundation consensus statement on the cardiac assessment of kidney transplant candidates provides some guidance on the selection of asymptomatic patients for further non-invasive risk stratification. Additionally, the novel selective A2A receptor-agonist vasodilator stress agent, regadenoson, is safe and effective in ESRD and has recently been approved by the Food and Drug Administration for use in this population. Ancillary stress MPI findings, namely heart rate response to vasodilator stress, can provide incremental risk stratification.

Summary

While myocardial perfusion imaging is widely used as a risk assessment tool, its utilization and clinical implications in the ESRD population are controversial. Though stress SPECT-MPI has imperfect diagnostic accuracy in this specific patient population, it is still a valuable non-invasive modality in cardiovascular risk assessment.

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  1. Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA

    Yasmeen Golzar & Rami Doukky

  2. Division of Cardiology, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky

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  1. Yasmeen Golzar
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Rami Doukky served on an advisory board and receives research funding from Astellas Pharma Global Development (Northbrook, IL). Yasmeen Golzar has no conflict to report.

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Golzar, Y., Doukky, R. Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease. Curr Cardiovasc Imaging Rep 10, 13 (2017). https://doi.org/10.1007/s12410-017-9409-1

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