Noninvasive cardiac risk stratification of diabetic and nondiabetic uremic renal allograft candidates using dipyridamole-thallium-201 imaging and radionuclide ventriculography

Brown, Kenneth A.; Rimmer, Jeffrey M.; Haisch, Carl E.

doi:10.1016/0002-9149(89)90800-x

Cited by 80 publications

(22 citation statements)

References 18 publications

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“…Two studies did not meet the criterion of independent reporting of MI and cardiac death and were excluded (27,28). One abstract was potentially relevant, but it contained insufficient data to classify MI and cardiac death by MPS result (29).…”

Section: Resultsmentioning

confidence: 99%

“…Bates and colleagues reported that in 53 patients that a new wall motion abnormality was associated with future cardiac events (odds ratio 12.7) (21). Brown et al (27) found that both reversible defects on thallium scintigraphy and left ventricular dysfunction were independently associated with the combined outcome of future MI or CD. Recently, we have confirmed the findings of these investigators.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation

Rabbat¹,

Treleaven²,

Russell³

et al. 2003

Journal of the American Society of Nephrology

158

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Abstract. The prognostic utility of myocardial perfusion studies (MPS) such as thallium scintigraphy and dobutamine stress echocardiography (DSE) for stratifying cardiac risk among candidates for kidney or kidney-pancreas transplantation is uncertain. This study is a meta-analysis to determine the prognostic significance of MPS results on future myocardial infarction (MI) and cardiac death (CD) in patients with end-stage renal disease (ESRD) assessed for kidney or kidney-pancreas transplantation. MEDLINE was searched using combinations of MeSH headings and text words for transplantation, coronary artery disease, prognosis, end-stage renal disease, and noninvasive cardiac testing (nuclear scintigraphy and DSE) for primary studies. Studies were included if they reported MPS results and cardiac events in patients assessed for kidney or kidney-pancreas transplantation. Methodologic study quality and outcome data were independently abstracted in duplicate by two researchers. The relative risks (RR) of MI and CD were calculated using a random effects model. Twelve articles met all inclusion criteria; 12 studies reported CD, and 9 reported MI. In eight studies, thallium scintigraphy was used (four with pharmacologic stress, four with exercise stress), whereas four used DSE. When compared with negative tests, positive tests had a significantly increased RR of MI (2.73 [95% CI, 1.25 to 5.97]; P ϭ 0.01) and CD (2.92 [95% CI, 1.66 to 5.12]; P Ͻ 0.001). Subgroup analyses of studies of diabetic patients indicated that positive tests were associated with a RR of CD 3.95 (95% CI, 1.48 to 10.5; P ϭ 0.006) and a RR of MI 2.68 (95% CI, 0.95 to 7.57; P ϭ 0.06) when compared with negative tests. In studies evaluating mixed populations of diabetic and nondiabetic patients, positive tests were associated with a RR of CD 2.52 (95% CI, 1.25 to 5.08; P ϭ 0.01) and with a RR of MI 2.79 (95% CI, 0.85 to 9.21; P ϭ 0.09) when compared with a negative test. The presence of reversible defects was associated with an increased risk of MI in diabetic patients and of CD in both subgroups; fixed defects were associated with an increased risk of CD but not MI. It is concluded that positive MPS are useful in identifying patients with significantly increased risk of future MI and CD in both diabetic and nondiabetic ESRD patients. Cardiovascular disease is common in individuals with endstage renal disease (ESRD) and accounts for between 40 and 45% of all deaths in these patients (1,2). At the time of initiation of chronic dialysis treatment in 1999, approximately 25% of patients have a history of ischemic heart disease and about 10% have had myocardial infarction (MI) (2,3). Although the rate of death from cardiac disease in ESRD patients in the United States fell in the 8-yr period between 1991 and 1998, the incident rate of MI rose in the second and third years of treatment by 15.7% and 6.8%, respectively (4). In addition, the short-term and long-term prognosis after acute MI in ESRD patients is poor, with 40% of patients dying of cardiac causes at ...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation

Rabbat¹,

Treleaven²,

Russell³

et al. 2003

Journal of the American Society of Nephrology

158

View full text Add to dashboard Cite

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“…uninephrectomy, caused greatly accelerated atherogenesis [9]. In agreement with this notion, both autopsy studies [10] and studies using coronarography [11] or electron beam computed tomography [12][13][14] directly documented an excessive prevalence of coronary atherosclerosis in dialysis patients.…”

Section: Ritzmentioning

confidence: 75%

Atherosclerosis in Dialyzed Patients

Ritz¹

2004

Blood Purif

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In the recent HEMO study, the most common cause of death in dialyzed patients was ischemic heart disease. In Europe there are regional differences, but the mortality due to cardiovascular disease is also very high. The long-lasting controversy whether the high incidence and prevalence of atherosclerotic manifestations (particularly ischemic heart disease) may be explained by known risk factors, or non-traditional risk factors are also involved seems to be partially solved with the increasing evidence that the latter hypothesis is true. Thus, together with classic risk factors such as hypertension, dyslipidemia and diabetes, other situations such as microinflammation, increased concentration of asymmetrical dimethyl-L-arginine, disturbed phosphate metabolism and anemia may represent important risk factors for accelerated atherosclerosis in dialyzed patients.

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“…2). [23][24][25][26][27][28][29][30][31][32][33][34] Thc pooled data for dipyridamole myocardial perfusion imaging reveal a positive and negative predictive value of 36 f: 1 1 % and 07 i 2%, respectively. The positive predictive value of a severe defect, defined as a multisegmental, reversible defect or a combination of fixed and reversible defect for cardiac events was 45 * 5% and is associated with an increased incidence of postoperative death and myocardial infarction.…”

Section: Stms -Myocardial Perfusion Imaging In Assessing Preoperativementioning

confidence: 94%

Preoperative strategies to assess cardiac risk before noncardiac surgery

Younis

Miller

Chaitman

1995

Clinical Cardiology

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Summary:The strategies recommended in the preoperative cardiac risk assessment prior to major vascular and nonvascular surgery are reviewed. The role of clinical evaluation, noninvasive stress testing (exercise test, stress myocardial perfusion imaging, stress echocardiography), and Holter monitoring during the preoperative evaluation are outlined and the value of intervention based on the use of each test is discussed. Recommended strategies to evaluate patients based on their clinical risk markers in addition to the results of the noninvasive risk assessment are presented.

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Noninvasive cardiac risk stratification of diabetic and nondiabetic uremic renal allograft candidates using dipyridamole-thallium-201 imaging and radionuclide ventriculography

Cited by 80 publications

References 18 publications

Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation

Prognostic Value of Myocardial Perfusion Studies in Patients with End-Stage Renal Disease Assessed for Kidney or Kidney-Pancreas Transplantation

Atherosclerosis in Dialyzed Patients

Preoperative strategies to assess cardiac risk before noncardiac surgery

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