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Background Imaging-based measures of atherosclerosis such as coronary artery calcium score (CACS) and coronary flow reserve (CFR) as well as carotid atherosclerotic plaque burden (cPB) are predictors of cardiovascular events in the general population. The objective of this study was to correlate CACS, cPB, myocardial blood flow (MBF), and CFR in patients with end-stage renal disease (ESRD). Methods and results 39 patients (mean age 53 ± 12 years) with ESRD prior to kidney transplantation were enrolled. MBF and CFR were quantified at baseline and under hyperemia by  13 N-NH 3 -PET/CT. CACS was calculated from low-dose CT scans acquired for PET attenuation correction. cPB was assessed by 3D ultrasound. Uni- and multivariate regression analyses between these and clinical parameters were performed. Median follow-up time for clinical events was 4.4 years. Kaplan–Meier survival estimates with log-rank test were performed with regards to cardiovascular (CV) events and death of any cause. CACS and cPB were associated in ESRD patients ( r  = 0.48;  p  ≤ 0.01). While cPB correlated with age ( r  = 0.43;  p    2.0 ( p  = 0.06 and  p  = 0.4). In contrast to MBF stress , there was neither a significant correlation between CFR and CACS ( r  = − 0.2;  p  = 0.91) nor between CFR and cPB ( r  = − 0.1;  p  = 0.55). CV event-free survival was associated with reduced CFR and MBF stress  ( p  = 0.001 and  p  &lt; 0.001) but not with cPB or CACS. Conclusions CACS, cPB, and MBF stress  are associated in patients with ESRD. Atherosclerosis is earlier detected by MBF stress  than by CFR. CV event-free survival is associated with impaired CFR and MBF stress .

journal of nuclear cardiology

Coronary artery calcium burden, carotid atherosclerotic plaque burden, and myocardial blood flow in patients with end-stage renal disease: A non-invasive imaging study combining PET/CT and 3D ultrasound