The role of myocardial perfusion SPECT in short-term cardiac prognosis of end-stage renal disease

Introduction: One of the most important causes of death in patients with end-stage renal disease (ESRD) and even after kidney transplantation is cardiovascular diseases. Thus, cardiac evaluation is of utmost importance in the management of these patients especially during preoperative work up before renal transplantation. The aim of present study is to evaluate the role of myocardial perfusion imaging (MPI) in short-term prognosis of cardiac events in patients with ESRD. Methods: In this cohort study, patients with ESRD who were referred for MPI before kidney transplantation, during a two years’ time interval (December 2015- 2017) were evaluated. Those patients aged ≥30 years were included. Patients with a history of previous transplantation, congenital heart diseases, low MPI quality and incomplete /questionable history or follow-up data were excluded. The patients were subsequently followed by reviewing their hospital records, outpatient interviews and if required telephone contacts. The occurrence of cardiac related death, myocardial infarction and/or revascularization procedure was considered positive for short-term cardiac events. Results: A total of 179 patients (67% males with mean age of 52 years) were included in this study. The mean follow-up duration was 15.3±6.6 months (2 to 32 months) during which, one hundred patients received kidney transplantation. The coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia and abnormal MPI findings were more prevalent in patients with cardiac events. Whereas those who had undergone kidney transplantation, developed fewer cardiac events during the follow up period. However, in multivariate Cox proportional hazard analysis only abnormal MPI findings and positive history of CAD were independent predictors of cardiac events. The kidney transplantation was a significantly protective marker. Other cardiac risk factors and none of quantitative perfusion parameters of MPI showed a significant association with cardiac events in multivariate Cox proportional hazard models. Conclusion: According to our study, abnormal MPI and previous CAD history were the best predictor of short-term cardiac events. The kidney transplantation can lead to a better short-term cardiovascular prognosis.