Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography

BACKGROUND/AIMS: Normal myocardial perfusion is closely associated with very low rates of cardiac events and better long-term outcomes; however, little is known about its prognostic value in patients with end-stage renal disease (ESRD). METHODS: A total of 286 incident patients underwent baseline ca...

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Autores principales: Park, Gun Ha, Song, Jae Won, Lee, Chang Min, Song, Young Rim, Kim, Sung Gyun, Kim, Hyung Jik, Kim, Jwa Kyung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association of Internal Medicine 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768542/
https://www.ncbi.nlm.nih.gov/pubmed/27871168
http://dx.doi.org/10.3904/kjim.2016.116
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author Park, Gun Ha
Song, Jae Won
Lee, Chang Min
Song, Young Rim
Kim, Sung Gyun
Kim, Hyung Jik
Kim, Jwa Kyung
author_facet Park, Gun Ha
Song, Jae Won
Lee, Chang Min
Song, Young Rim
Kim, Sung Gyun
Kim, Hyung Jik
Kim, Jwa Kyung
author_sort Park, Gun Ha
collection PubMed
description BACKGROUND/AIMS: Normal myocardial perfusion is closely associated with very low rates of cardiac events and better long-term outcomes; however, little is known about its prognostic value in patients with end-stage renal disease (ESRD). METHODS: A total of 286 incident patients underwent baseline cardiac evaluations using echocardiography and stress-rest single-photon emission computed tomography. Perfusion scans for 177 patients (61.9%) who had a summed stress score (SSS) < 4 were normal. RESULTS: During the 4-year follow-up period, 79 cardiac events occurred. Patients with a SSS < 4 had significantly lower annual rates of cardiac events than did those with a SSS ≥ 4 (6.4% vs. 13.2%; hazard ratio, 0.54; 95% confidence interval, 0.31 to 0.94). Among patients with a SSS < 4, however, cardiac event rates significantly differed according to the presence of comorbid conditions such as old age, diabetes, history of coronary artery disease, and elevated C-reactive protein levels. In addition, the presence of left ventricular (LV) systolic dysfunction and LV hypertrophy at the start of hemodialysis strongly influenced future cardiac events. CONCLUSIONS: In patients with ESRD, normal perfusion scans usually indicate a significantly low risk of adverse cardiac events. However, even in patients with normal perfusion scans, the cardiovascular prognosis is largely dependent on baseline inflammation levels and comorbidities.
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spelling pubmed-57685422018-01-19 Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography Park, Gun Ha Song, Jae Won Lee, Chang Min Song, Young Rim Kim, Sung Gyun Kim, Hyung Jik Kim, Jwa Kyung Korean J Intern Med Original Article BACKGROUND/AIMS: Normal myocardial perfusion is closely associated with very low rates of cardiac events and better long-term outcomes; however, little is known about its prognostic value in patients with end-stage renal disease (ESRD). METHODS: A total of 286 incident patients underwent baseline cardiac evaluations using echocardiography and stress-rest single-photon emission computed tomography. Perfusion scans for 177 patients (61.9%) who had a summed stress score (SSS) < 4 were normal. RESULTS: During the 4-year follow-up period, 79 cardiac events occurred. Patients with a SSS < 4 had significantly lower annual rates of cardiac events than did those with a SSS ≥ 4 (6.4% vs. 13.2%; hazard ratio, 0.54; 95% confidence interval, 0.31 to 0.94). Among patients with a SSS < 4, however, cardiac event rates significantly differed according to the presence of comorbid conditions such as old age, diabetes, history of coronary artery disease, and elevated C-reactive protein levels. In addition, the presence of left ventricular (LV) systolic dysfunction and LV hypertrophy at the start of hemodialysis strongly influenced future cardiac events. CONCLUSIONS: In patients with ESRD, normal perfusion scans usually indicate a significantly low risk of adverse cardiac events. However, even in patients with normal perfusion scans, the cardiovascular prognosis is largely dependent on baseline inflammation levels and comorbidities. The Korean Association of Internal Medicine 2018-01 2016-11-22 /pmc/articles/PMC5768542/ /pubmed/27871168 http://dx.doi.org/10.3904/kjim.2016.116 Text en Copyright © 2018 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Park, Gun Ha
Song, Jae Won
Lee, Chang Min
Song, Young Rim
Kim, Sung Gyun
Kim, Hyung Jik
Kim, Jwa Kyung
Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
title Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
title_full Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
title_fullStr Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
title_full_unstemmed Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
title_short Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
title_sort long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768542/
https://www.ncbi.nlm.nih.gov/pubmed/27871168
http://dx.doi.org/10.3904/kjim.2016.116
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