Prognostic Risk Stratification of Cardiac Events Evaluated by Aortic Calcification in Elderly Patients with Chronic Kidney Disease

Abstract

Background : The relationship between myocardial perfusion imaging (MPI) and aortic calcification (AoC) in chronic kidney disease (CKD) patients remains unclear. Methods : The Japanese Assessment of Cardiac Events and Survival Study by quantitative gated single-photon emission computed tomography (J-ACCESS 3) is a multicenter, prospective cohort study investigating the ability of MPI to predict cardiac events in 529 CKD patients. In J-ACCESS 3, the sum of myocardial perfusion defect score at stress (SSS) was a useful predictor of cardiac major events in CKD patients. However, aortic calcification was not examined. We examined the prognosis of patients with CKD according to the presence or absence of AoC using data from the J-ACCESS 3 cohort. Results : There were 60 major cardiac events (three cardiac deaths, six sudden deaths, five non-fatal myocardial infarctions, 46 hospitalization cases for heart failure). In the univariate analysis, patients with AoC had a higher left ventricular (LV) ejection fraction, smaller LV volume, and lower SSS by MPI. Kaplan ‒ Meier curves showed a significantly higher incidence of major cardiac events in the AoC group (P = 0.0041). Patients were categorized into the following four groups: Group A (non-AoC and SSS < 4; normal score of 0 ‒ 3); Group B (AoC and SSS < 4); Group C (non-AoC and SSS ≧ 4); Group D (AoC and SSS ≧ 4). Kaplan ‒ Meier curves showed that the major cardiac events rates were A < B < C < D (P = 0.002). The difference was most pronounced between the AoC and no-AoC groups with SSS < 4. Conclusions : The combination of SSS using MPI and AoC is a useful predictor of cardiac major events in CKD patients.