The diagnostic accuracy of stress myocardial perfusion scintigraphy in patients with end-stage renal disease

Objective: This study examined the diagnostic accuracy of myocardial perfusion scintigraphy (MPS) in end-stage renal disease (ESRD) patients and the incidence and clinical and biochemical predictors of myocardial perfusion abnormalities. Methods: We evaluated 500 asymptomatic ESRD patients on hemodialysis referred for MPS for cardiac risk stratification before renal transplant surgery. Patients with abnormal MPS and an additional few patients without abnormal MPS underwent invasive coronary angiography (ICA). Results: Sixty-nine patients (13%) showed abnormal MPS (reversible or fixed defect). The majority of patients had cardiovascular risk factors. There were statistically significant differences in age, male gender, hypertension, diabetes, hypercholesterolemia, and left ventricular ejection fraction (LVEF) (P < 0.05 for each) between patients with normal and abnormal MPS. Multivariate regression analysis showed that age (>= 62 years) and low LVEF (<= 47%) were independent predictors for abnormal MPS. ICA was performed in 112 subjects; the sensitivity, specificity, positive predictive value, and negative predictive value of MPA to detect CAD is 72%, 70%, 79%, and 61%, respectively. Conclusions: In ESRD, the incidence of myocardial perfusion defects is 13%. In addition to other traditional CAD risk factors, such as diabetes and hypertension, age, and LVEF are the strongest predictors of MPS abnormalities. Initial risk stratification can be cost-effective for identifying high-risk patients who will benefit from more imaging with CAD risk factors and LVEF. In ESRD patients, MPS diagnostic performance is relatively poor. To further evaluate the utility of MPS in diagnosis and risk stratification in ESRD, more data is therefore required.