Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences and Central Arkansas VA Medical Center, Little Rock, AR, USA Department of Internal Medicine, Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI 48202, USA.
Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences and Central Arkansas VA Medical Center, Little Rock, AR, USA.
Eur Heart J Cardiovasc Imaging. 2014 Aug;15(8):933-40. doi: 10.1093/ehjci/jeu036. Epub 2014 Apr 3.
Patients with chronic kidney disease (CKD) have worse cardiovascular outcomes. The prognostic value of the new pharmacological stressor regadenoson (REG) in patients with varying levels of kidney function is not known (REG-SPECT). Furthermore, the impact of varying levels of kidney dysfunction on cardiac outcomes in patients undergoing REG-SPECT has not been defined. Our objective was to evaluate the prognostic value of regadenoson stress imaging in patients with different levels of kidney dysfunction.
We followed 1107 consecutive patients who underwent REG-SPECT for a mean duration of 1.8 ± 0.8 years. CKD was defined as estimated glomerular filtration rate (GFR) 60 mL/min/1.73 m(2). Kaplan-Meier survival analysis was performed to evaluate survival, free of major adverse cardiac events (MACE). CKD patients with GFR <60 (47% male, mean age 70 years) had a higher prevalence of cardiac risk factors and a history of coronary artery disease and were on significantly more cardiac medications (P < 0.001) than those with GFR >60. Patients with GFR <60 were significantly more likely to develop adverse cardiac outcomes including congestive heart failure (CHF) (P = 0.02), cardiac death (P < 0.001), all-cause death (P < 0.001), and MACE (P < 0.001) over the period of follow-up. Cardiac death increased with worsening levels of perfusion defects (SSS) across the entire spectrum of renal function (P < 0.001). GFR <60 was an independent predictor of MACE with a hazard ratio (HR) of 1.49 (95% CI: 1.06-2.08). The presence of transient ischaemic dilation (TID) was associated with an HR of 5.06 (95% CI: 1.43-17.90).
Renal function is a powerful risk predictor in patients undergoing REG-SPECT. REG-SPECT provides robust prognostication across the entire spectrum of renal function.
患有慢性肾脏病（CKD）的患者心血管结局更差。新的药物应激剂雷加登松（REG）在肾功能不同水平的患者中的预后价值尚不清楚（REG-SPECT）。此外，肾功能不同程度的障碍对接受 REG-SPECT 的患者心脏结局的影响尚未确定。我们的目的是评估不同程度肾功能障碍患者接受 REG 应激成像的预后价值。
我们对 1107 例连续接受 REG-SPECT 的患者进行了平均 1.8±0.8 年的随访。CKD 的定义为估算肾小球滤过率（GFR）<60ml/min/1.73m2。采用 Kaplan-Meier 生存分析评估无重大不良心脏事件（MACE）的生存情况。GFR<60 的 CKD 患者（47%为男性，平均年龄 70 岁）具有更高的心脏危险因素和冠心病病史，且服用的心脏药物明显更多（P<0.001）。GFR<60 的患者发生不良心脏事件的风险显著更高，包括充血性心力衰竭（CHF）（P=0.02）、心脏死亡（P<0.001）、全因死亡（P<0.001）和 MACE（P<0.001）。在整个肾功能范围内，心脏死亡随灌注缺陷（SSS）程度的恶化而增加（P<0.001）。GFR<60 是 MACE 的独立预测因素，风险比（HR）为 1.49（95%CI：1.06-2.08）。短暂性缺血扩张（TID）的存在与 HR 为 5.06（95%CI：1.43-17.90）相关。
肾功能是 REG-SPECT 患者的有力风险预测因子。REG-SPECT 在整个肾功能范围内提供可靠的预后评估。
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