Background and Objectives: In patients with CKD and end-stage kidney disease (ESKD), cardiac stress testing has low sensitivity and specificity for coronary disease. Alternate markers that are derived during the stress testing may enhance the predictive characteristic of stress testing. The objective was to examine the predictive characteristic of lung-to-heart ratio (LHR) in patients with CKD and ESKD. Design, Setting, Participants, and Measurements: Retrospective parallel cohort of ESKD and CKD not on dialysis (CKD-ND) who underwent stress testing with nuclear myocardial perfusion imaging utilizing sestamibi tracer and regadenoson. Stress LHR was calculated by the processing software and reported. Patients were analyzed by tertile of LHR (≤0.28, 0.29–0.32, ≥0.33). The primary outcome was a composite of all-cause mortality, hospitalization for myocardial infarction or unstable angina, or revascularization. Results: There were 144 CKD-ND and 145 ESKD patients. Patients with ESKD had greater comorbidity burden than CKD-ND. Stress tests were more often performed for pre-operative risk assessment among ESKD versus CKD-ND (53.8 vs. 5.6%, p #x3c; 0.001). ESKD patients more likely had ischemia identified on stress testing (19.3 vs. 8.3%, p = 0.001). Mean LHR was 0.31 (Standard deviation – SD: 0.09) and was similar across CKD-ND stages and ESKD. Primary outcome in the lowest (23%) and highest (33.3%) LHR tertile was higher than the middle tertile (12.8%); p = 0.005. This finding was similar between CKD-ND and ESKD and persisted in multivariable analysis. Conclusions: LHR ≤0.28 and ≥0.33 are independently associated with higher risk for death in patients with CKD-ND and ESKD. Future studies are warranted to understand the association of extreme LHR values and outcomes in this high-risk population.
Cardiorenal Med

中文翻译：

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肺 Sestamibi 摄取对慢性肾脏病心肌灌注成像和结果的影响

背景与目的：在 CKD 和终末期肾病 (ESKD) 患者中，心脏负荷试验对冠心病的敏感性和特异性较低。在压力测试期间派生的替代标记可以增强压力测试的预测特性。目的是检查 CKD 和 ESKD 患者肺心比 (LHR) 的预测特征。设计、设置、参与者和测量：回顾性平行队列 ESKD 和 CKD 未进行透析 (CKD-ND)，他们使用 sestamibi 示踪剂和 regadenoson 进行了核心肌灌注成像的压力测试。应力 LHR 由处理软件计算并报告。通过 LHR 的三分位数（≤0.28、0.29–0.32、≥0.33）对患者进行分析。主要结果是全因死亡率、因心肌梗塞或不稳定心绞痛住院或血运重建的复合结果。结果： CKD-ND 患者 144 例，ESKD 患者 145 例。与 CKD-ND 相比，ESKD 患者的合并症负担更大。在 ESKD 与 CKD-ND 之间，更常进行压力测试以进行术前风险评估（53.8% 与 5.6%，p#x3c; 0.001）。ESKD 患者更有可能在压力测试中发现缺血（19.3 对 8.3%，p = 0.001）。平均 LHR 为 0.31（标准偏差 - SD：0.09），并且在 CKD-ND 阶段和 ESKD 之间相似。最低 (23%) 和最高 (33.3%) LHR 三分位数的主要结果高于中间三分位数 (12.8%)；p = 0.005。这一发现在 CKD-ND 和 ESKD 之间是相似的，并且在多变量分析中持续存在。结论： LHR ≤0.28 和≥0.33 与 CKD-ND 和 ESKD 患者较高的死亡风险独立相关。未来的研究有必要了解极端 LHR 值与这一高危人群中的结果之间的关联。
心肾医学