Published Online
on September 8, 2009

A more recent version of this article appeared on November 1, 2009

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Original Article

Incremental Prognostic Value of Myocardial Perfusion Imaging in Patients Referred to Stress SPECT with Renal Dysfunction

Mouaz H. Al-Mallah; Rory Hachamovitch; Sharmila Dorbala and Marcelo Di Carli¹

Brigham & Women's Hospital, Harvard Medical School, Boston, MA

^* Corresponding author; email: mdicarli{at}partners.org

Background—Coronary artery disease is the main cause of mortality and morbidity in patients with impaired renal function. The aim of this study is to evaluate the prognostic implications of single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with impaired renal function.

Methods and Results—We included 7348 consecutive patients (mean age 64 ± 13 years, 51% males) referred for SPECT-MPI between 3/02 and 10/06. Renal function was estimated using the estimated glomerular filtration rate (GFR) formula. Patients were followed up for the incidence of all cause mortality. Patients with decreased GFR were more often older with higher prevalence of conventional risk factors (p<.001). After a median follow-up 2.6 years (25^th - 75^th percentile 1.5 - 3.7), 693(9.4%) patients died. The risk of death increased with worsening kidney function. At each stage of impaired renal function, patients with abnormal SPECT-MPI had increased hazard of adverse events (p<.0001). Using Cox proportional hazard analysis, the magnitude of total perfusion deficit and ischemia on MPI were associated with worse outcome after adjusting for confounding variables including GFR and ejection fraction.

Conclusions—SPECT-MPI adds modest incremental prognostic information to identify patients at higher relative risk of death across a wide spectrum of renal function.

Key Words: coronary disease • imaging • kidney • mortality • nuclear medicine • scintigraphy • end stage renal disease • renal insufficiency • single-photon emission computed tomography myocardial perfusion imaging