TY - JOUR T1 - Normal stress myocardial perfusion imaging has a limited prognostic value in patients with severely reduced renal function: a sub-study of J-ACCESS3 JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 509 LP - 509 VL - 59 IS - supplement 1 AU - Shinro Matsuo AU - Kenichi Nakajima AU - Yasuchika Takeishi AU - Tsunehiko Nishimura Y1 - 2018/05/01 UR - http://jnm.snmjournals.org/content/59/supplement_1/509.abstract N2 - 509Background: Patients with chronic kidney disease (CKD) have a higher risk of cardiovascular events and death than those without. Coronary artery disease (CAD) in CKD patients is frequently silent. To maximize the effective treatment of cardiovascular disease in patients with CKD, it is important to identify CAD objectively in CKD patients in a noninvasive way as early as possible. Risk stratification is essential for the development of evidence-based strategies for improved patient care in medicine in CKD patients. In general, patients with normal SPECT images had a lower risk of death and hard cardiac events, whereas in patients with abnormal myocardial perfusion, the mortality and hard cardiac event rates became significantly higher. However, the clinical significance of normal SPECT images in CKD patients who might have higher cardiovascular events has not yet been clarified. Therefore, the purpose of this study is to test the hypothesis that a normal myocardial perfusion imaging (MPI) study in chronic kidney disease (CKD) can provide benign prognostic information for the prediction of major cardiovascular events. Results: A multicenter study of Japanese assessment of cardiac events and survival studies by quantitative gated SPECT (J-ACCESS)-3 registry was a prognostic cohort study involving 62 institutions using stress MPI. All institutions employed certified physicians for examination of CAD, and the patients could participate in a 3-year follow-up. Among J-ACCESS3 subjects, this sub-study included subjects with normal perfusion imaging. The study group consisted of 431 CKD patients (males, 64 %; mean age, 72 ± 11 years) with normal SPECT imaging. All SPECT data in the Digital Images and Communication in Medicine format were processed at the J-ACCESS office (Osaka, Japan). An image interpretation committee objectively evaluated defect scores to achieve objective scoring. The committee consisted of seven collaborative physicians who evaluated digitally the submitted SPECT images in a blinded manner. The committee determined defect scores using summed stress/rest/difference scores (SSS/SRS/SDS) with a 17-segment model, confirming computer generated defect scores ranging from 0 (normal uptake) to 4 (defect). Thresholds for scoring were based on the normal database of the Japanese Society of Nuclear Medicine working group. Based on SPECT image and QGS data, 331 had a summed stress score of 3 or less, a summed difference score of 1 or less and normal cardiac function (males; end-systolic volume (ESV) ≤ 60mL, females; ESV ≤ 40mL, males, ejection fraction (EF) ≥ 49%; females, EF ≥ 50 %). Out of 431 subjects with normal myocardial perfusion imaging (SSS ≤ 3), 331 were defined as normal perfusion and normal cardiac function, which accounted for 77 % of the cases in this study population. During a three-year follow-up period, there were a total of 27 major cardiovascular events, including cardiac death (n = 3), sudden death (n = 3), and acute coronary syndrome (n = 3), and 19 were hospitalized because of congestive heart failure. Kaplan-Meier analysis showed that major cardiovascular events in patients with higher eGFR of ≥ 15 ml/min) were very low, and regarded as low risk. According to the eGFR status, namely <15 (n = 58), 15 to < 30 (n = 97), 30 to < 45 (n = 131), 45 ≤ (n = 45), the higher cardiac event rate was observed in patients with eGFR of < 15 mL/min among the 4 groups. Major cardiovascular event rate in patients with lowest eGFR (< 15) was twice as much than that in patients with eGFR of ≥30 mL/min. Lower hemoglobin (males, < 12 g/dl; females, < 11 g/dl) and higher CRP (CPR ≥ 0.3 mg/dL) were also the predictors of increased risk. Conclusion: The clinical value of normal SPECT imaging was confirmed in a large-scale clinical trial. Normal stress SPECT images confer benign prognosis in patients with CKD, but care must be taken when treating severely reduced renal function, which is associated with higher cardiac event. ER -