Document Detail


Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis.
MedLine Citation:
PMID:  19296103     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Diabetic patients with chronic kidney disease (CKD) frequently develop cardiac events within several years of the initiation of haemodialysis. The present study assesses the prognostic significance of stress myocardial ECG-gated perfusion imaging (MPI) in patients with diabetic CKD requiring haemodialysis. METHODS: Fifty-five asymptomatic patients with diabetic stage V CKD and no history of heart disease scheduled to start haemodialysis were enrolled in this study (56 +/- 11 years old; 49 with type 2 diabetes mellitus). All patients underwent (201)Tl stress ECG-gated MPI 1 month before or after the initiation of haemodialysis to assess myocardial involvement. We evaluated SPECT images using 17-segment defect scores graded on a 5-point scale, summed stress score (SSS) and summed difference scores (SDS). The patients were followed up for at least 2 years (42 +/- 15 months) to determine coronary intervention (CI) and heart failure (HF) as soft events and acute myocardial infarction (AMI) and all causes of deaths as hard events. RESULTS: The frequencies of myocardial ischaemia, resting perfusion defects, low ejection fraction and left ventricular (LV) dilatation were 24, 20, 29 and 49%, respectively. Ten events (18%) developed during the follow-up period including four CI, one HF, one AMI and four sudden deaths. Multivariate Cox analysis selected SDS (p = 0.0011) and haemoglobin A(1c) (HbA(1c)) (p = 0.0076) as independent prognostic indicators for all events. CONCLUSION: Myocardial ischaemia, in addition to glycaemic control, is a strong prognostic marker for asymptomatic patients with diabetic CKD who are scheduled to start haemodialysis. Stress MPI is highly recommended for the management and therapeutic stratification of such patients.
Authors:
Mitsuru Momose; Tetsuya Babazono; Chisato Kondo; Hideki Kobayashi; Takatomo Nakajima; Kiyoko Kusakabe
Related Documents :
16996863 - Relation between soluble intercellular adhesion molecule-1, statin therapy, and long-te...
15586633 - Usefulness of 123i-metaiodobenzylguanidine myocardial scintigraphy in the prediction of...
16721263 - Elevated high-mobility group box 1 levels in patients with cerebral and myocardial isch...
Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2009-03-19
Journal Detail:
Title:  European journal of nuclear medicine and molecular imaging     Volume:  36     ISSN:  1619-7089     ISO Abbreviation:  Eur. J. Nucl. Med. Mol. Imaging     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-13     Completed Date:  2009-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140988     Medline TA:  Eur J Nucl Med Mol Imaging     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1315-21     Citation Subset:  IM    
Affiliation:
Department of Radiology, Tokyo Women's Medical University, School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. mmomose@rad.twmu.ac.jp
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Cardiac-Gated Imaging Techniques
Chronic Disease / therapy
Diabetes Complications / complications,  diagnosis*,  radionuclide imaging,  therapy*
Electrocardiography
Female
Humans
Ischemia / etiology,  physiopathology,  radionuclide imaging
Kidney Diseases / complications,  diagnosis*,  radionuclide imaging,  therapy*
Male
Middle Aged
Myocardial Infarction / etiology,  physiopathology,  radionuclide imaging
Myocardial Perfusion Imaging
Prognosis
Renal Dialysis*
Stress, Physiological*
Survival Rate

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


Previous Document:  Noninvasive imaging of tumor integrin expression using (18)F-labeled RGD dimer peptide with PEG (4) ...
Next Document:  Comparison of various surgical methods in the treatment of implant-related infection.