Prognostic Utility of BOLD Cardiovascular Magnetic Resonance Imaging in Chronic Kidney Disease

Cardiovascular disease is common in patients with chronic kidney disease (CKD). Coronary artery disease (CAD) is a major cause of death in CKD patients. However, early disease can be asymptomatic. This makes it important to investigate and diagnose the condition early. There are several available functional testing methods for detecting significant CAD and myocardial ischemia. However there are many limitations to these methods including low sensitivity/specificity, multi-vessel involvement and test interpretation difficulties in CKD patients, and increased incidence of systemic nephrogenic sclerosis (rare but potentially lethal condition) in CKD patients after use of Cardiac Magnetic Resonance (CMR) Perfusion Imaging.

Thus we need a more sensitive and specific functional testing method that is both reliable and safe for use in CKD patients. Blood Oxygen Level Dependent (BOLD) CMR imaging has a relatively high sensitivity/specificity and a low risk profile. It allows us to visualize the actual oxygenation status of the myocardial tissue and thus gives us a clearer understanding of myocardial ischaemia. We aim to study 150 patients with CKD or renal transplant with echocardiography and BOLD CMR to evaluate myocardial ischaemia and its potential role as a prognostic tool to predict risk for cardiovascular death, heart failure hospitalisation and acute coronary syndrome at 2 years.

We have already published preliminary results of this work, and if confirmed in the larger trial, this work has the potential to considerably improve clinical care in patients with CKD.