Department of Cardiology, University of Helsinki, Haartmaninkatu 8, Helsinki, Finland.
Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
Eur Heart J Cardiovasc Imaging. 2018 Sep 1;19(9):1019-1025. doi: 10.1093/ehjci/jex200.
The value of single-photon emission tomography (SPECT) in patients with severe chronic kidney disease is controversial, and the implications of SPECT finding with lower level of ischaemia are unknown. We assessed the prognostic value of SPECT in patients evaluated for kidney transplantation.
Five hundred and forty-eight patients underwent SPECT as a part of routine evaluation for kidney transplantation. During the median follow-up of 43.7 months (IQR 22.4-68.4 months), 112 patients (20.4%) died, 49 of cardiovascular (CV) causes (8.9%). In comparison to those with no perfusion defects, mild perfusion abnormalities (1%-9.9%) had an adjusted Cox hazard ratio (HR) of 1.80 [95% confidence interval (95% CI) 1.02-3.17, P = 0.041] for all-cause mortality, while large perfusion defects (≥10%) demonstrated an HR of 2.20 (95% CI 1.38-3.50, P = 0.001). A competing risk analysis produced a similar prognostic capacity for CV mortality. SPECT also offered incremental prognostic impact with two reclassification methods. Revascularization was performed clearly more often on patients with severely than mildly abnormal or normal SPECT (28.0%, 4.3%, and 1.3%, respectively, P < 0.001). However, revascularization was not linked with better survival. Patients with a normal SPECT received a kidney transplant more often than patients with a mildly or severely abnormal SPECT (50.5%, 36.2%, and 36.6%, respectively, P = 0.010).
Myocardial ischaemia in SPECT is clearly linked with mortality in patients screened for kidney transplantation. Contrary to populations with coronary artery disease, even a mild perfusion defect in SPECT predicts poor prognosis in this patient population. The finding deserves further attention in forthcoming trials.
单光子发射计算机断层扫描（SPECT）在严重慢性肾脏病患者中的价值存在争议，且 SPECT 显示低缺血程度的影响尚不清楚。我们评估了 SPECT 在接受肾移植评估患者中的预后价值。
548 例患者接受 SPECT 作为肾移植常规评估的一部分。在中位随访 43.7 个月（IQR 22.4-68.4 个月）期间，112 例患者（20.4%）死亡，其中 49 例（8.9%）死于心血管（CV）原因。与无灌注缺损相比，轻度灌注异常（1%-9.9%）的全因死亡率校正 Cox 风险比（HR）为 1.80 [95%置信区间（95%CI）1.02-3.17，P=0.041]，而大灌注缺损（≥10%）则为 2.20（95%CI 1.38-3.50，P=0.001）。竞争风险分析显示，CV 死亡率也具有类似的预后能力。两种重新分类方法也为 SPECT 提供了额外的预后影响。再血管化在 SPECT 严重异常、轻度异常和正常患者中进行的频率明显更高（分别为 28.0%、4.3%和 1.3%，P<0.001）。然而，再血管化与更好的生存率无关。SPECT 正常的患者比 SPECT 轻度或严重异常的患者更常接受肾移植（分别为 50.5%、36.2%和 36.6%，P=0.010）。
在接受肾移植筛查的患者中，SPECT 显示心肌缺血与死亡率明显相关。与冠心病患者群体不同，即使 SPECT 显示轻度灌注缺损也预示着该患者群体预后不良。这一发现值得在未来的试验中进一步关注。
