1Nuclear Medicine, Royal Free Hospital, London, UK
2Renal Unit, Royal Free Hospital, London, UK
*Correspondence to: Consultant- Nuclear Medicine, Royal Free Hospital, Pond Street, London NW3 2QG, UK. Telephone: +44(0) 20 7830 2470, Fax: +44(0) 20 7472 6202, Email: j.buscombe@inedsch.ucl.ac.uk
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 99mTc-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 99mTc-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 99mTc-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.
Renal failure, Myocardial Perfusion Scintigraphy, Bull'S-Eye
