Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan,
Ann Nucl Med. 2013 Oct;27(8):729-36. doi: 10.1007/s12149-013-0739-z. Epub 2013 May 28.
Relationships between myocardial scintigraphic parameters and renal function have not been fully determined. We investigated correlations between estimated glomerular filtration rate (eGFR) and left ventricular (LV) diastolic function using stress electrocardiographic (ECG)-gated myocardial single photon emission computed tomography (SPECT).
We enrolled 136 consecutive patients with suspected coronary artery disease (CAD) who were assessed using technetium-99m stress ECG-gated myocardial SPECT. We evaluated SPECT images using 17-segment defect scores graded on a 5-point scale, summed stress score, summed rest score and summed difference score (SDS). The parameters for assessing LV diastolic function were peak filling rate (PFR), 1/3 mean filling rate and time to peak filling. The CAD was defined as SDS ≥2. Chronic kidney disease (CKD) was defined as eGFR <60 mL/min/1.73 m(2). Patients were assigned to the following four groups (no CAD/no CKD: control group, n = 68; CAD/no CKD: CAD group, n = 24; no CAD/CKD: CKD group, n = 34; CAD/CKD: CAD + CKD group, n = 10).
The PFR was significantly impaired after stress in the CKD and CAD + CKD groups compared with controls (p < 0.001 for both). Furthermore, PFR at rest positively correlated with eGFR (r = 0.29, p < 0.001) and inversely correlated with SDS (r = -0.18, p < 0.05). Multivariate stepwise regression analysis independently associated eGFR with PFR (β coefficient = 0.260, p = 0.002).
Our data suggest that impaired renal function is a significant determinant of LV diastolic dysfunction in patients with suspected CAD.
心肌闪烁显像参数与肾功能之间的关系尚未完全确定。我们通过心电图（ECG）门控心肌单光子发射计算机断层扫描（SPECT）研究了估计肾小球滤过率（eGFR）与左心室（LV）舒张功能之间的相关性。
我们纳入了 136 例疑似冠心病（CAD）的连续患者，使用锝-99m 应激 ECG 门控心肌 SPECT 进行评估。我们使用 5 分制 17 节段缺损评分、总和应激评分、总和静息评分和总和差异评分（SDS）评估 SPECT 图像。评估 LV 舒张功能的参数为峰值充盈率（PFR）、1/3 平均充盈率和达到峰值充盈的时间。CAD 定义为 SDS≥2。慢性肾脏病（CKD）定义为 eGFR<60 mL/min/1.73 m2。患者分为以下四组（无 CAD 无 CKD：对照组，n=68；CAD 无 CKD：CAD 组，n=24；无 CAD CKD：CKD 组，n=34；CAD CKD：CAD+CKD 组，n=10）。
与对照组相比，CKD 和 CAD+CKD 组在应激后 PFR 明显受损（均 p<0.001）。此外，静息时的 PFR 与 eGFR 呈正相关（r=0.29，p<0.001），与 SDS 呈负相关（r=-0.18，p<0.05）。多元逐步回归分析独立地将 eGFR 与 PFR 相关联（β系数=0.260，p=0.002）。
我们的数据表明，肾功能受损是疑似 CAD 患者 LV 舒张功能障碍的重要决定因素。
