Document Detail


Evaluation of diabetic patients for renal and pancreas transplantation: noninvasive screening for coronary artery disease using radionuclide methods.
MedLine Citation:
PMID:  8932262     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pharmacologic stress thallium scintigraphy is commonly performed in the risk assessment of diabetic patients with nephropathy before kidney and/or pancreas transplantation; however, controversy exists regarding the test's accuracy in detecting coronary artery disease. Our purpose was to compare pharmacologic stress thallium scintigraphy and also exercise radionuclide ventriculography with coronary angiography in diabetic patients undergoing evaluation for transplantation. In addition, we also determined the association of the test results with outcome after transplantation. The medical records of 47 patients (mean age, 37+/-9 years) without clinical evidence of coronary artery disease were reviewed. Forty-one patients had pharmacologic stress thallium scintigraphy performed during their evaluation. Sensitivity was 62% and specificity was 76% for detecting > or = 75% coronary artery stenosis (sensitivity was 53% and specificity was 73% for > or = 50% stenosis). Thirty-five patients had exercise radionuclide ventriculography performed. Sensitivity was 50% and specificity was 67% for detecting > or = 75% coronary artery stenosis (sensitivity was 44% and specificity was 63% for > or = 50% stenosis). Thirty patients had both pharmacologic stress thallium scintigraphy and exercise radionuclide ventriculography performed; when either test was abnormal, sensitivity in the detection of > or = 50% or > or = 75% stenosis tended to increase compared with pharmacologic stress thallium scintigraphy alone (0.05<P<0.10), whereas specificity decreased (P<0.01). The incidence of adverse cardiac outcomes was identical for patients with abnormal thallium scintigrams and undergoing transplantation (2/11) compared with patients with normal scintigrams and undergoing transplantation (4/22). We conclude that: (1) pharmacologic stress thallium scintigraphy and exercise radionuclide ventriculography are suboptimal screening tests for coronary artery disease in diabetic patients awaiting kidney and/or pancreas transplantation; (2) using the two radionuclide tests in combination results in a decrease in specificity; and (3) patients with abnormal thallium scintigrams can receive transplants with outcomes similar to those for patients with normal thallium scintigrams.
Authors:
B F Vandenberg; J D Rossen; M Grover-McKay; N W Shammas; T L Burns; K Rezai
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation     Volume:  62     ISSN:  0041-1337     ISO Abbreviation:  Transplantation     Publication Date:  1996 Nov 
Date Detail:
Created Date:  1997-01-02     Completed Date:  1997-01-02     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1230-5     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Coronary Angiography / adverse effects
Diabetes Mellitus / physiopathology,  therapy*
Exercise Test
Humans
Kidney Transplantation*
Pancreas Transplantation*
Patient Selection*
Predictive Value of Tests
Radionuclide Imaging / adverse effects
Thallium / adverse effects
Treatment Outcome
Chemical
Reg. No./Substance:
7440-28-0/Thallium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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