Ineffectiveness of Dipyridamole Spect Thallium Imaging as a Screening Technique for Coronary Artery Disease in Patients With End-Stage Renal Failure

Marwick, Thomas H.; Steinmuller, Donald; Underwood, Donald A.; Hobbs, Robert E.; Go, Raymundo T.; Swift, Claudia; Braun, William E.

doi:10.1097/00007890-199001000-00022

Cited by 177 publications

(88 citation statements)

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“…Although we studied only a limited number of patients, poor sensitivity of dipyridamole thallium scintigraphy for the detection of significant CAS among CKD patients was demonstrated, as was found by Marwick et al (7). The common causes of a false-negative thallium study include single-vessel disease, balanced multivessel disease with global ischemia, and collaterals that prevent the detection of differential flow changes.…”

Section: Discussionmentioning

confidence: 60%

“…Because of a reduced exercise capacity as a result of anemia, peripheral vascular disease, or peripheral neuropathy, dipyridamole is usually used to produce cardiac stress in dialysis patients instead of exercise. However, Marwick et al (7) reported that dipyridamole single photon emission computed tomography thallium imaging was not effective in ESRD patients (50% false-positive rate and 83% false-negative rate). It is also clear that stress electrocardiography has limitations related to a high prevalence of electrolyte disorders and/or left ventricular hypertrophy in ESRD patients.…”

mentioning

confidence: 99%

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High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

Ohtake¹,

Kobayashi²,

Moriya³

et al. 2005

Journal of the American Society of Nephrology

262

166

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The prevalence of coronary artery stenosis (CAS) at the initiation of renal replacement therapy (RRT) in patients with chronic kidney disease (CKD) and no previous history of angina and/or myocardial infarction (MI) has not been fully elucidated. The prevalence of significant CAS was evaluated in 30 asymptomatic stage 5 CKD patients without a history of angina and/or MI by coronary angiography at the initiation of RRT. The correlations of various parameters with the prevalence of CAS were also examined. Atherosclerotic surrogate markers, including intima-media thickness of carotid artery and ankle-brachial BP index (ABI), were also evaluated. Significant CAS (>50% stenosis) was seen in 16 (53.3%) of 30 asymptomatic CKD patients on coronary angiography at the start of RRT. Stress cardiac scintigraphy was not effective for detecting hidden cardiac ischemia among the CKD patients. Univariate analysis showed that diabetes (P ‫؍‬ 0.01), left ventricular mass index (P ‫؍‬ 0.04), hyperlipidemia (P ‫؍‬ 0.04), total cholesterol (P ‫؍‬ 0.02), LDL cholesterol (P < 0.01), intima-media thickness (P ‫؍‬ 0.04), and fibrinogen (P ‫؍‬ 0.01) were positively correlated with the presence of CAS, whereas ABI (P < 0.01) showed a negative correlation with CAS. Stepwise logistic regression analysis revealed that diabetes and fibrinogen were significant and independent risk factors for CAS in asymptomatic CKD patients who started RRT. The results clearly demonstrated that despite the absence of cardiac events, stage 5 CKD patients are already in a very high risk group for CAS at the initiation of RRT, which was also closely associated with a significant decrease in ABI.

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Section: Discussionmentioning

confidence: 60%

mentioning

confidence: 99%

High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

Ohtake¹,

Kobayashi²,

Moriya³

et al. 2005

Journal of the American Society of Nephrology

262

166

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“…15 Marwick et al found that while the sensitivity of dipyridamole thallium scintigraphy for detecting obstructive CAD was 95% in non-CKD control group, it was only 37% in dialysis patients even after matching for severity and extent of CAD. 16 In this study, the probability of obstructive CAD in patients with normal SPECT was 38%. Finally, in a meta-analysis of nine studies of myocardial perfusion SPECT in potential kidney transplant recipients, the pooled sensitivity was 74% with a pooled sensitivity of 70%, both with wide confidence intervals ( Table 1).…”

Section: Stress Test In Ckd/esrd Patientsmentioning

confidence: 55%

“…Finally, in a meta-analysis of nine studies of myocardial perfusion SPECT in potential kidney transplant recipients, the pooled sensitivity was 74% with a pooled sensitivity of 70%, both with wide confidence intervals ( Table 1). 13 The reason for reduced sensitivity of myocardial perfusion SPECT in CKD/ESRD patients is not clearly known but has been attributed to a number of mechanisms 16 : (a) ''balanced ischemia'' due to multivessel disease resulting in global ischemia. Patients with CKD have increased prevalence of multivessel disease.…”

Section: Stress Test In Ckd/esrd Patientsmentioning

confidence: 99%

Stress testing in patients with chronic kidney disease: The need for ancillary markers for effective risk stratification and prognosis

Bangalore

2016

Journal of Nuclear Cardiology

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“…A major concern with MPS is that in CKD there is already higher resting blood flow due to higher basal adenosine levels [33] . As a result, the challenge induced to flow reserve from pharmacologic stimulation is attenuated, so that any measurable difference in uptake of the administered radioisotope in different myocardial regions will be attenuated as well [34] . Particular caution in interpreting results from MPS is warranted in CKD patients with PAD [35] .…”

Section: Myocardial Perfusion Scintigraphymentioning

confidence: 99%

Screening for cardiovascular disease before kidney transplantation

Palepu

Prasad

2015

WJT

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Pre-kidney transplant cardiac screening has garnered particular attention from guideline committees as an approach to improving post-transplant success. Screening serves two major purposes: To more accurately inform transplant candidates of their risk for a cardiac event before and after the transplant, thereby informing decisions about proceeding with transplantation, and to guide pre-transplant management so that posttransplant success can be maximized. Transplant candidates on dialysis are more likely to be screened for coronary artery disease than those not being considered for transplantation. Thorough history and physical examination taking, resting electrocardiography and echocardiography, exercise stress testing, myocardial perfusion scintigraphy, dobutamine stress echocardiography, cardiac computed tomography, cardiac biomarker measurement, and cardiac magnetic resonance imaging all play contributory roles towards screening for cardiovascular disease before kidney transplantation. In this review, the importance of each of these screening procedures for both coronary artery disease and other forms of cardiac disease are discussed.

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Ineffectiveness of Dipyridamole Spect Thallium Imaging as a Screening Technique for Coronary Artery Disease in Patients With End-Stage Renal Failure

Cited by 177 publications

References 0 publications

High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

High Prevalence of Occult Coronary Artery Stenosis in Patients with Chronic Kidney Disease at the Initiation of Renal Replacement Therapy

Stress testing in patients with chronic kidney disease: The need for ancillary markers for effective risk stratification and prognosis

Screening for cardiovascular disease before kidney transplantation

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