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European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

01.08.2009 | Original Article

Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis

verfasst von: Mitsuru Momose, Tetsuya Babazono, Chisato Kondo, Hideki Kobayashi, Takatomo Nakajima, Kiyoko Kusakabe

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 8/2009

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Abstract

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 ²⁰¹Tl 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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Titel: Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis
verfasst von: Mitsuru Momose
Tetsuya Babazono
Chisato Kondo
Hideki Kobayashi
Takatomo Nakajima
Kiyoko Kusakabe
Publikationsdatum: 01.08.2009
Verlag: Springer-Verlag
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 8/2009
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-009-1110-4

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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