Indian Journal of Nuclear Medicine
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Year : 2007  |  Volume : 22  |  Issue : 2  |  Page : 36-40

Myocardial perfusion scintigraphy combined with pharmacological exercise in patients with end stage renal disease on haemodialysis-diagnostic and prognostic implications

1 Nuclear Medicine, Royal Free Hospital, London, United Kingdom
2 Nuclear Medicine, Royal Free Hospital; Renal Unit, Royal Free Hospital, London, United Kingdom

Correspondence Address:
John R Buscombe
Consultant- Nuclear Medicine, Royal Free Hospital, Pond Street, London NW3 2QG
United Kingdom
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Source of Support: None, Conflict of Interest: None

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In patients with end stage renal disease on dialysis; cardiovascular disease is frequently under diagnosed because of the non-classical presentation of symptoms. The aim of the study was to (a) evaluate the importance and the diagnostic accuracy of 99m Tc-Tetrofosmin myocardial perfusion scintigraphy (MPS) with pharmacological exercise (b) assess the progression of coronary heart disease in patients with renal failure using a semi-quantitative method. A retrospective review was performed in 141 patients (M=86, F=55) (Mean age 56 yrs) all whom underwent stress testing with adenosine using the standard dosage regimes and were imaged with a one-day stress/rest protocol using Tc-99m tetrofosmin. 36/141 patients had an additional second stress and rest 99m Tc-myocardial perfusion scintigraphy with a mean interval of 15-months (range 12-30 months). The tomographic slices were reconstructed anduptake in the heart quantified and compared to a normal data set to remove reader bias. 95 out of 141 patients (67%) had abnormal scans, 69(73%) had reversible and 26(27%) irreversible defects. 27(28.4%) patients had perfusion abnormality involving a single territory, 35(36.8%) involving two territories, and 8(8.4%) three territories. In addition 25(26.3%) patients had diffuse or patchy perfusion abnormalities. In 36 patients who had 2 scans, there was evidence ofprogression of cardiac disease in 21/36 (58%) patients. Using objective measurement of myocardial perfusion, the vast majority of patients on dialysis have abnormal 99m Tc-Tetrofosmin myocardial perfusion scintigraphy often in more than one territory. It would also appear that there is also progression of defects seen on myocardial perfusion scintigraphy over a short time period. Myocardial perfusion scintigraphies are therefore useful in the diagnosis and follow-up of patients with renal failure on dialysis.

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