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

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-NH3-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 < 0.01), CACS did not. MBF(stress)was negatively associated with age (r = 0.44;p < 0.01) and time on dialysis (r = 0.42;p < 0.01). There were negative correlations between MBF(stress)and CACS (r = - 0.62;p < 0.001) and between MBF(stress)and cPB (r = - 0.43;p < 0.01). Age and CACS were the strongest predictors for MBFstress. CFR was impaired (< 2.0) in eight patients who also presented with higher cPB and higher CACS compared to those with a CFR > 2.0 (p = 0.06 andp = 0.4). In contrast to MBFstress, 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 MBFstress(p = 0.001 andp < 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 MBFstress.