Translate this page into:
Myocardial Perfusion Scintigraphy Combined with Pharmacological Exercise in Patients with End Stage Renal Disease on Haemodialysis-Diagnostic and Prognostic Implications
Correspondence to: Correspondence to: Dr. J.R. Buscombe Consultant- Nuclear Medicine, Royal Free Hospital Pond Street, London NW3 2QG, UK. Telephone: +44(0) 20 7830 2470, Fax: +44(0) 20 7472 6202 Email: j.buscombe@medsch.ucl.ac.uk
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
In patients with end stage renal disease on dialysis; cardiovascular disease is frequently under diagnosed because of the non-classical presentation of symptoms. The aim of the study was to (a) evaluate the importance and the diagnostic accuracy of 99mTc-Tetrofosmin myocardial perfusion scintigraphy (MPS) with pharmacological exercise (b) assess the progression of coronary heart disease in patients with renal failure using a semi-quantitative method. A retrospective review was performed in 141 patients (M=86, F=55) (Mean age 56 yrs) all whom underwent stress testing with adenosine using the standard dosage regimes and were imaged with a one-day stress/rest protocol using Tc-99m tetrofosmin. 36/141 patients had an additional second stress and rest 99mTc-myocardial perfusion scintigraphy with a mean interval of 15-months (range 12-30 months). The tomographic slices were reconstructed anduptake in the heart quantified and compared to a normal data set to remove reader bias. 95 out of 141 patients (67%) had abnormal scans, 69(73%) had reversible and 26(27%) irreversible defects. 27(28.4%) patients had perfusion abnormality involving a single territory, 35(36.8%) involving two territories, and 8(8.4%) three territories. In addition 25(26.3%) patients had diffuse or patchy perfusion abnormalities. In 36 patients who had 2 scans, there was evidence ofprogression of cardiac disease in 21/36 (58%) patients. Using objective measurement of myocardial perfusion, the vast majority of patients on dialysis have abnormal 99mTc-Tetrofosmin myocardial perfusion scintigraphy often in more than one territory. It would also appear that there is also progression of defects seen on myocardial perfusion scintigraphy over a short time period. Myocardial perfusion scintigraphies are therefore useful in the diagnosis and follow-up of patients with renal failure on dialysis.
