BACKGROUND: Non-invasive detection of coronary artery disease in dialysis patients, a major cause of mortality, often remains difficult. The aim of the study was to test the diagnostic and prognostic accuracies of combined dipyridamole-exercise thallium imaging in dialysis patients. METHODS: Dipyridamole-exercise thallium imaging and coronary angiography were both performed prospectively in 60 asymptomatic hemodialysis patients who were followed up, long term, by recording any major coronary event. RESULTS: Coronary angiography was abnormal in 13 patients (21%), and there was abnormal thallium uptake in 17 patients. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of thallium to detect a coronary artery disease were 92, 89, 71, 98 and 90%, respectively. After a median follow-up of 2.8 years, 12 patients experienced at least one major coronary event (4 cardiac deaths, 5 myocardial infarctions and 3 revascularizations). Eight of the 17 patients with abnormal thallium uptake (47%) suffered a coronary event, compared to only 4 of the 43 patients (9%) with a normal thallium uptake (P < 0.001). The positive prognostic predictive value of thallium imaging was 47% and its negative predictive value was 91%. The probability of survival free of coronary events was significantly higher in patients with normal thallium uptake than in those with abnormal thallium uptake (crude risk ratio 7.6; P < 0.001) even after adjustment for several risk factors for cardiovascular disease (adjusted risk ratio 9.2; P < 0.005). CONCLUSION: In dialysis patients, combined dipyridamole-exercise thallium imaging is an accurate method for detecting coronary stenosis and for predicting future coronary events.
BACKGROUND: Non-invasive detection of coronary artery disease in dialysis patients, a major cause of mortality, often remains difficult. The aim of the study was to test the diagnostic and prognostic accuracies of combined dipyridamole-exercise thallium imaging in dialysis patients. METHODS:Dipyridamole-exercise thallium imaging and coronary angiography were both performed prospectively in 60 asymptomatic hemodialysis patients who were followed up, long term, by recording any major coronary event. RESULTS: Coronary angiography was abnormal in 13 patients (21%), and there was abnormal thallium uptake in 17 patients. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of thallium to detect a coronary artery disease were 92, 89, 71, 98 and 90%, respectively. After a median follow-up of 2.8 years, 12 patients experienced at least one major coronary event (4 cardiac deaths, 5 myocardial infarctions and 3 revascularizations). Eight of the 17 patients with abnormal thallium uptake (47%) suffered a coronary event, compared to only 4 of the 43 patients (9%) with a normal thallium uptake (P < 0.001). The positive prognostic predictive value of thallium imaging was 47% and its negative predictive value was 91%. The probability of survival free of coronary events was significantly higher in patients with normal thallium uptake than in those with abnormal thallium uptake (crude risk ratio 7.6; P < 0.001) even after adjustment for several risk factors for cardiovascular disease (adjusted risk ratio 9.2; P < 0.005). CONCLUSION: In dialysis patients, combined dipyridamole-exercise thallium imaging is an accurate method for detecting coronary stenosis and for predicting future coronary events.
Authors: Louis W Wang; Magid A Fahim; Andrew Hayen; Ruth L Mitchell; Laura Baines; Stephen Lord; Jonathan C Craig; Angela C Webster Journal: Cochrane Database Syst Rev Date: 2011-12-07
Authors: Robert C Hendel; Brian G Abbott; Timothy M Bateman; Ron Blankstein; Dennis A Calnon; Jeffrey A Leppo; Jamshid Maddahi; Matthew M Schumaecker; Leslee J Shaw; R Parker Ward; David G Wolinsky Journal: J Nucl Cardiol Date: 2011-02 Impact factor: 5.952
Authors: Lygeri P Soubassi; Theodore C Chiras; Emmanuel D Papadakis; George D Poulos; Dimitrios I Chaniotis; Ioannis P Tsapakidis; Sofia P Soubassi; Stylianos N Zerefos; Nikolaos S Zerefos; Dimitrios A Valis Journal: Int Urol Nephrol Date: 2006 Impact factor: 2.370
Authors: R Parker Ward; Mouaz H Al-Mallah; Gabriel B Grossman; Christopher L Hansen; Robert C Hendel; Todd C Kerwin; Benjamin D McCallister; Rupa Mehta; Donna M Polk; Peter L Tilkemeier; Aseem Vashist; Kim Allan Williams; David G Wolinsky; Edward P Ficaro Journal: J Nucl Cardiol Date: 2007 Nov-Dec Impact factor: 5.952
Authors: Krista L Lentine; Frank P Hurst; Rahul M Jindal; Todd C Villines; Jeffrey S Kunz; Christina M Yuan; Paul J Hauptman; Kevin C Abbott Journal: Am J Kidney Dis Date: 2009-09-23 Impact factor: 8.860