Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk, with coronary artery disease being a leading cause of morbidity and mortality. Conventional cardiovascular risk scores and non-invasive diagnostic tests have limited accuracy in this population, partly due to atypical symptoms and frequent structural heart disease. Coronary flow reserve (CFR) is a key marker of coronary microvascular dysfunction and has strong prognostic value, but its assessment is usually limited to invasive techniques. Recent advances in cadmium-zinc-telluride single-photon emission computed tomography (CZT-SPECT) allow non-invasive measurement of CFR. The EVACKD study aims to evaluate the prognostic value of CFR assessed by CZT-SPECT in patients with CKD for predicting major adverse cardiovascular events over a 2-year follow-up.

Inclusion Criteria:

• Male or female patients aged over 18 years
• Affiliated with the French social security system
• Patients at renal risk based on albuminuria (Alb) and glomerular filtration rate (GFR < 30 mL/min/1.73 m², or GFR < 45 mL/min/1.73 m² with albuminuria > 30 mg/g, or GFR < 60 mL/min/1.73 m² with albuminuria > 300 mg/g)
• Patients undergoing, independently of the research and according to the clinician's decision as part of standard care, CZT-SPECT myocardial perfusion imaging with coronary flow reserve measurement for cardiovascular risk assessment
• Having expressed no objection to participation in this study

Exclusion Criteria:

• Legally protected adult (Article L1121-8 of the French Public Health Code)
• Person deprived of liberty (Article L1121-8 of the French Public Health Code)
• Pregnant woman
• Patient who has undergone a normal coronary exploration within the past year

Patients from the University Hospital of Grenoble