Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
- Author:
Gun Ha PARK
1
;
Jae Won SONG
;
Chang Min LEE
;
Young Rim SONG
;
Sung Gyun KIM
;
Hyung Jik KIM
;
Jwa Kyung KIM
Author Information
- Publication Type:Original Article
- From:The Korean Journal of Internal Medicine 2018;33(1):148-156
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS:Normal myocardial perfusion is closely associated with very low rates of cardiac events and better long-term outcomes; however, little is known about its prognostic value in patients with end-stage renal disease (ESRD).
METHODS:A total of 286 incident patients underwent baseline cardiac evaluations using echocardiography and stress-rest single-photon emission computed tomography. Perfusion scans for 177 patients (61.9%) who had a summed stress score (SSS) < 4 were normal.
RESULTS:During the 4-year follow-up period, 79 cardiac events occurred. Patients with a SSS < 4 had significantly lower annual rates of cardiac events than did those with a SSS ≥ 4 (6.4% vs. 13.2%; hazard ratio, 0.54; 95% confidence interval, 0.31 to 0.94). Among patients with a SSS < 4, however, cardiac event rates significantly differed according to the presence of comorbid conditions such as old age, diabetes, history of coronary artery disease, and elevated C-reactive protein levels. In addition, the presence of left ventricular (LV) systolic dysfunction and LV hypertrophy at the start of hemodialysis strongly influenced future cardiac events.
CONCLUSIONS:In patients with ESRD, normal perfusion scans usually indicate a significantly low risk of adverse cardiac events. However, even in patients with normal perfusion scans, the cardiovascular prognosis is largely dependent on baseline inflammation levels and comorbidities.
