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The prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) has not been specifically studied in patients with end-stage renal disease (ESRD).

Methods and Results

We prospectively followed ESRD patients enrolled in the ASSUAGE and ASSUAGE-CKD trials in which they received regadenoson-stress 99mTc-tetrofosmin SPECT-MPI. Images were semiquantitatively analyzed by an investigator blinded to clinical and outcome data. Patients were followed for cardiac death, myocardial infarction (MI), and coronary revascularization (CR). Revascularizations occurring >90 days post-MPI were considered “late” events. Survival analysis was performed using Cox regression models, adjusting for age, gender, diabetes, dyslipidemia, smoking, and known coronary artery disease. We analyzed 303 patients (mean age 54 years; 64% men), who were followed for 35 ± 10 months. Adjusting for clinical covariates, abnormal regadenoson-stress MPI (SSS ≥ 4) was associated with increased risk of the composite of cardiac death or MI (23.9% vs 14.4%; HR 1.88; CI 1.04-3.41; P = .037) and the composite of cardiac death, MI, or late CR (27.3% vs 16.7%; HR 1.80; CI 1.03-3.14; P = .039). Adjusting for clinical covariates, regadenoson-induced myocardial ischemia (SDS ≥ 2) was associated with increased rate of the composite endpoint of cardiac death, MI, or CR (33.3% vs 16.9%; HR 1.97; CI 1.19-3.27; P = .008).

Conclusion

Regadenoson-stress SPECT-MPI provides a significant prognostic value in patients with ESRD. ESRD patients with normal SPECT-MPI have relatively high adverse event rates.

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Abbreviations

CAD:

Coronary artery disease

CR:

Coronary revascularization

ESRD:

End-stage renal disease

LV:

Left ventricular

MI:

Myocardial infarction

MPI:

Myocardial perfusion abnormality

SDS:

Summed difference score

SPECT:

Single-photon emission computed tomography

SSS:

Summed stress score

TID:

Transient ischemic dilation

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Disclosure

Rami Doukky serves on the Advisory Board for Astellas Pharma and receives research funding from Astellas Pharma. Other authors have no conflicts to report.

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Authors and Affiliations

  1. Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA

    Rami Doukky MD, MSc, FACC, FASNC

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

    Rami Doukky MD, MSc, FACC, FASNC, Ibtihaj Fughhi MD, MSc, Tania Campagnoli MD & Marwan Wassouf MD

  3. Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA

    Amjad Ali MD

Authors
  1. Rami Doukky MD, MSc, FACC, FASNC
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  2. Ibtihaj Fughhi MD, MSc
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  3. Tania Campagnoli MD
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  4. Marwan Wassouf MD
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  5. Amjad Ali MD
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Corresponding author

Correspondence to Rami Doukky MD, MSc, FACC, FASNC.

Additional information

See related editorial, doi:10.1007/s12350-015-0337-7.

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Doukky, R., Fughhi, I., Campagnoli, T. et al. The prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease. J. Nucl. Cardiol. 24, 112–118 (2017). https://doi.org/10.1007/s12350-015-0303-4

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  • DOI: https://doi.org/10.1007/s12350-015-0303-4

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