Cardiac risk assessment by gated single-photon emission computed tomography in asymptomatic end-stage renal disease patients at the start of dialysis.

ABSTRACT

OBJECTIVES: This study assessed the impact of cardiac risk assessment using gated single-photon emission computed tomography (SPECT) on cardiac events in end-stage renal disease (ESRD) patients. METHODS: We evaluated 215 asymptomatic patients who began dialysis between January 2005 and April 2009. Baseline electrocardiography and echocardiography were performed in all the patients. The subjects were stratified into low- and high-risk groups according to the baseline cardiac status, and gated SPECT was additionally recommended for the high-risk patients. RESULTS: The study population consisted of 50 low- and 165 high-risk patients undergoing SPECT. Among the high-risk patients, 75 (45.5%) showed perfusion defects on SPECT and their overall cardiac-event rate per person-year of follow-up was 15.0%, significantly higher than 4.5% in high-risk group without perfusion defect and 1.2% in low-risk group. The presence of perfusion defect was a significant independent predictor of adverse cardiac events [hazard ratio (HR) 2.11; 95% confidence interval (CI) 1.05-4.24; P = .035]. When gated SPECT was added to the clinical and the echocardiographic variables, the prognostic stratification significantly improved (P < .001). However, coronary revascularization was not associated with improved cardiac event-free survival (HR 0.62; 95% CI 0.26-1.52; P = .296). CONCLUSIONS: Gated SPECT may provide additional prognostic information for cardiac risk stratification, particularly among high-risk patients starting dialysis.