| Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis. | |
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MedLine Citation:
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PMID: 19296103 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Mitsuru Momose; Tetsuya Babazono; Chisato Kondo; Hideki Kobayashi; Takatomo Nakajima; Kiyoko Kusakabe |
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Publication Detail:
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Type: Clinical Trial; Journal Article Date: 2009-03-19 |
Journal Detail:
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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:
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Created Date: 2009-07-13 Completed Date: 2009-09-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101140988 Medline TA: Eur J Nucl Med Mol Imaging Country: Germany |
Other Details:
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Languages: eng Pagination: 1315-21 Citation Subset: IM |
Affiliation:
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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 |
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| MeSH Terms | |
Descriptor/Qualifier:
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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
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