King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, P.O. Box 22490, Riyadh, 11426, Saudi Arabia.
Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA.
J Nucl Cardiol. 2018 Oct;25(5):1658-1673. doi: 10.1007/s12350-016-0756-0. Epub 2017 Jan 3.
Traditional cardiovascular (CV) risk factors have limited predictive value of CV mortality in patients with chronic kidney disease (CKD, creatinine clearance less than 60 mL/minute per 1.73 m). The aim of this study was to evaluate incremental and independent prognostic value of single-photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) across continuum of renal function.
We retrospectively studied 11,518 (mean age, 65 ± 12 years; 52% were men) patients referred for a clinical indication of SPECT-MPI between April 2004 and May 2009. Primary end point was composite of cardiac death and non-fatal myocardial infarction (CD/MI). We examined the relationship of total perfusion defect (TPD) and CD/MI in multiple Cox regression models for CV risk factors and GFR. The incremental predictive value of TPD was examined using Harrell's c-index, net reclassification index (NRI), and integrated discrimination index (IDI).
Over a median follow-up of 5 years (25th to 75th percentiles, 3.0-6.5 years), 1,692 (14.5%) patients experienced CD/MI (740 MI and 1,182 CD). In a multivariable model adjusted for traditional CV risk factors and GFR, the presence of a perfusion defect was independently associated with increased risk of CD/MI (HR = 2.10; 95% CI 1.81, 2.43, p < .001). Using Cox regression, TPD improved the discriminatory ability beyond traditional CV risk factors and GFR [from AUC = 0.725, (95% CI 0.712-0.738) to 0.784, (95% CI 0.772-0.796), p < .0001]. Furthermore, TPD improves risk stratification of CKD patients over and above traditional CV risk factors and GFR [NRI = 14%, 95% CI (12%-16%, p < .001) and relative IDI = 60%, 95% CI (51%, 66%, p < .001)].
Across the spectrum of renal function, SPECT-MPI perfusion defects independently and incrementally reclassified patients for their risk of CD/MI, beyond traditional CV risk factors.
传统心血管（CV）危险因素对慢性肾脏病（CKD，肌酐清除率<60 mL/min/1.73 m）患者的 CV 死亡率的预测能力有限。本研究的目的是评估单光子发射计算机化断层扫描心肌灌注成像（SPECT-MPI）在整个肾功能范围内的增量和独立预后价值。
我们回顾性研究了 2004 年 4 月至 2009 年 5 月期间因临床指征接受 SPECT-MPI 检查的 11518 名（平均年龄 65±12 岁；52%为男性）患者。主要终点是心脏死亡和非致死性心肌梗死（CD/MI）的复合终点。我们在 CV 危险因素和肾小球滤过率（GFR）的多个 Cox 回归模型中检查了总灌注缺陷（TPD）与 CD/MI 的关系。使用 Harrell 的 c 指数、净重新分类指数（NRI）和综合判别指数（IDI）检查 TPD 的增量预测价值。
在中位随访 5 年（25%至 75%分位值为 3.0-6.5 年）期间，1692 名（14.5%）患者发生 CD/MI（740 例 MI 和 1182 例 CD）。在调整传统 CV 危险因素和 GFR 的多变量模型中，存在灌注缺陷与 CD/MI 的风险增加独立相关（HR=2.10；95%CI 1.81，2.43，p<0.001）。使用 Cox 回归，TPD 提高了传统 CV 危险因素和 GFR 之外的区分能力[从 AUC=0.725（95%CI 0.712-0.738）提高至 0.784（95%CI 0.772-0.796），p<0.0001]。此外，TPD 提高了 CKD 患者的风险分层，超过了传统 CV 危险因素和 GFR [NRI=14%（95%CI 12%-16%，p<0.001）和相对 IDI=60%（95%CI 51%-66%，p<0.001）]。
在整个肾功能范围内，SPECT-MPI 灌注缺陷独立且增量地重新分类了患者发生 CD/MI 的风险，超过了传统 CV 危险因素。
