Prognostic utility of negative stress/rest myocardial SPECT studies among patients with different clinical categories of chronic kidney disease: Data from an Egyptian cohort

Prognostic value of negative myocardial SPECT study is well established. However, patients with chronic kidney disease (CKD) are a special group showing increased risk of cardiac events. We thought to investigate the prognostic value of negative SPECT study among patients on regular hemodialysis compared to other clinical categories of CKD.Methods186 consecutive patients with CKD and negative SPECT study were enrolled. 93 (50%) were on hemodialysis with an eGFR<30mL/min/1.73m2 (Group I); 25 (13.4%) had uncomplicated renal transplantation with eGFR between 45 and 90mL/min/1.73m2 (Group II) and 68 (36.6%) with CKD on conservative management and no prior history of hemodialysis (eGFR between 30 and 60mL/min/1.73m2), Group (III). End points (CD, STEMI/NSTEMI, need for revascularization and hospitalized HF) were traced at 6months, one year and 2years.ResultsTotal events in all groups were 5 (2.70%) at 6months, and 18 (9.70%) and 36 (19.30%) at one year and 2years respectively. At one year 16 (17.20%) cardiac events happened in Group I compared to one (4.0%) and one (1.50%) event(s) in Groups II and III respectively (p values 0.001). At 2years, 29 (31.20%) cardiac events happened in Group I while 2 (8.0%) and 5 (7.30%) happened in Groups II and III respectively (p values 0.01, 0.001 respectively). eGFR and duration of hemodialysis were the independent predictors of cardiac events.ConclusionDespite negative MPI study, patients on hemodialysis showed higher event (including CD, STEMI/NSTEMI and revascularization) rate at one and 2years of follow-up compared to other clinical categories of CKD