EJNMMI research
Type of dialysis may influence the prognostic value of myocardial perfusion imaging in end stage renal disease: an observational [13N]NH3 PET/CT study
By Wenning C, Gosmann TM, Vrachimis A and 2 others.
Abstract
Background
Patients with end-stage renal disease (ESRD) exhibit an elevated risk of cardiovascular events, with imaging-based risk stratification becoming increasingly important. This study compares the prognostic utility of [13N]NH3 PET/CT assessing myocardial blood flow (MBF), coronary flow reserve (CFR) and coronary artery calcium score (CACS) as well as 3D carotid ultrasound (for carotid plaque burden; cPB) in hemodialysis (HD) versus peritoneal dialysis (PD) patients listed for kidney transplantation.
Results
41 ESRD patients (HD n = 31; PD n = 10; median follow-up 4.9 years) without known coronary artery disease underwent myocardial perfusion imaging with [13N]NH3 PET/CT, CACS, and 3D carotid ultrasound. HD patients exhibited lower myocardial stress blood flow (MBFstress) and CFR compared to PD patients (2.67 ± 0.67 vs. 2.97 ± 0.69; p = 0.24 and 2.5 ± 0.74 vs. 3.08 ± 1.12; p = 0.07). In the HD subgroup, only MBFstress correlated inversely with CACS and cPB (r = -0.32; p < 0.05 and r = -0.44; p < 0.05), whereas CFR did not (r=-0.14; p = 0.47 and r= -0.14; p = 0.44). On the other hand, both MBFstress and CFR were predictive of cardiovascular events in HD patients, although the number of events was low (n = 4). In contrast, PD patients exhibited only one single cardiovascular event in the follow-up and no significant imaging correlations were observed.