Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
J Cardiol. 2012 Nov;60(5):377-82. doi: 10.1016/j.jjcc.2012.06.011. Epub 2012 Aug 11.
Cardiovascular disease is the leading cause of death among patients with chronic kidney disease (CKD). Therefore, stratification of the prognostic risk of cardiovascular events is useful for their clinical management. We evaluated the ability of electrocardiogram (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT) to predict cardiac events among Japanese patients at all stages of CKD including those on hemodialysis.
Patients with CKD undergoing ECG-gated myocardial perfusion SPECT to investigate suspected ischemic heart disease were followed up to monitor retrospectively major cardiac events including cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. Summed stress score, summed rest score, and summed difference score were estimated with a 20 segment 5-point scoring model. The severity of CKD was divided into five levels based on estimated glomerular filtration rate (eGFR) revised for the Japanese population.
The follow-up period was 25.8 ± 11.0 months. Sixty-two major cardiac events (cardiac death, n=30; non-fatal myocardial infarction, n=13; unstable angina pectoris, n=19) developed in 2243 patients during the first year of follow-up. The findings of multivariate Cox proportional hazards regression analysis indicated that diabetes, eGFR, the summed difference score, and summed stress score were significant independent predictors of cardiac events. The major cardiac event rate at one year increased in proportion to the progression of CKD stage. The major cardiac event-free survival rate decreased steeply over time in patients with CKD stage 5 compared with those who had CKD stages 4 or less.
Myocardial perfusion SPECT can contribute to the prediction of cardiac events and survival in patients at all stages of CKD including those on hemodialysis.
心血管疾病是慢性肾脏病（CKD）患者死亡的主要原因。因此，对心血管事件的预后风险进行分层对其临床管理很有用。我们评估了心电图（ECG）门控心肌灌注单光子发射计算机断层扫描（SPECT）在包括血液透析患者在内的 CKD 所有阶段患者中预测心脏事件的能力。
对疑似缺血性心脏病进行 ECG 门控心肌灌注 SPECT 检查的 CKD 患者进行了回顾性随访，以监测主要心脏事件，包括心源性死亡、非致死性心肌梗死和不稳定型心绞痛。采用 20 节 5 分评分模型估算总和应激评分、总和静息评分和总和差值评分。根据为日本人群修订的估计肾小球滤过率（eGFR），将 CKD 的严重程度分为五个等级。
随访时间为 25.8±11.0 个月。在第一年的随访中，2243 例患者中有 62 例发生了 62 例主要心脏事件（心源性死亡，n=30；非致死性心肌梗死，n=13；不稳定型心绞痛，n=19）。多变量 Cox 比例风险回归分析结果表明，糖尿病、eGFR、总和差值评分和总和应激评分是心脏事件的独立预测因素。随着 CKD 分期的进展，一年内心脏事件发生率呈比例增加。与 CKD 分期 4 期或更低的患者相比，CKD 分期 5 期患者的主要心脏事件无事件生存率在随访期间急剧下降。
心肌灌注 SPECT 有助于预测包括血液透析患者在内的 CKD 所有阶段患者的心脏事件和生存。
