Value of thallium myocardial imaging in the prediction of future cardiovascular events in patients with end-stage renal failure.

Chronic renal failure is associated with an increased rate of premature death from cardiovascular disease. Non-invasive identification of asymptomatic cardiac disease should be valuable in the management of such patients, and in selection for transplantation. One hundred and three high-risk patients (66 male, 37 female) with chronic renal failure who were without cardiovascular symptoms were assessed by exercise-graded thallium myocardial perfusion imaging and followed prospectively for 4 years. The development of a cardiovascular event, or death, and the interval to event or death were recorded. Cardiovascular events were documented in 50 patients; in 44 of the 60 patients with a positive thallium test and in only six of the 43 patients with a negative thallium test (test sensitivity 88%, specificity 70%, predictive value of a positive test 73%). Forty patients died, 28 from cardiovascular causes, during the study period. Thallium myocardial perfusion imaging is of value in the prediction of future cardiovascular events in patients with chronic renal failure, and is a useful non-invasive screening technique in patients with end-stage renal failure being considered for transplantation.