Perfusion thallium imaging of type I diabetes patients with end stage renal disease: comparison of oral and intravenous dipyridamole administration.

Boudreau, Robert J.; Strony, John; duCret, Rene P.; Kuni, Christopher C.; Wang, Yan; Wilson, Robert F.; Schwartz, J. Sanford; Castañeda-Zúñiga, Wilfrido R.

doi:10.1148/radiology.175.1.2315467

Cited by 82 publications

(35 citation statements)

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“…No associations were found between the incidence of uCAD and the rate of statin use (C). 34) . Therefore, we believe that, even among dialysis patients, the diagnostic accuracy of MPS for detecting CAD is adequately reliable.…”

Section: Discussionmentioning

confidence: 99%

Declining Prevalence of Coronary Artery Disease in Incident Dialysis Patients Over the Past Two Decades

Iwasaki

Joki

Tanaka

et al. 2014

JAT

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Aim:The medical management of patients with chronic kidney disease (CKD) has changed within the past 20 years. We speculate that this change has resulted in a decrease in the prevalence of atherosclerotic cardiovascular disease in patients with CKD. The aim of the present study was to analyze changes in the prevalence of coronary artery disease (CAD) in patients newly started on hemodialysis, as well as trends in clinical factors and medications over the past two decades. Methods: This single-center cross-sectional study examined data for 315 consecutive patients starting hemodialysis (age, 64±12 years; men, 73%; diabetic nephropathy, 57%) between January 1993 and December 2010. All patients were routinely screened for CAD within three months of starting hemodialysis, regardless of whether ischemic heart disease was suspected. The patients were categorized into six groups based on the date of the initial dialysis session in order to compare the historical prevalence of unidentified CAD (uCAD) in association with the clinical factors. In addition, we performed a subgroup analysis among 222 patients without known cardiac disease. Results: The prevalence of uCAD gradually declined from 69% to 25% over 18 years (p＜0.001 for trend). The mean high-density lipoprotein cholesterol (HDL-C) concentration increased (p＜0.001 for trend), while the median C-reactive protein (CRP) level decreased over time. In parallel with these trends, the proportion of statin users significantly increased over time (p＜0.001 for trend). The use of erythropoiesis-stimulating agents (ESAs) and renin angiotensin aldosterone system inhibitors (RAS-Is) also increased during the same period (both p＜0.001 for trend). A univariate logistic regression analysis identified a significant association between the prevalence of uCAD and the use of ESAs (OR: 0.565, p= 0.016) or RAS-Is (OR: 0.501, p = 0.004). In addition, a lower BMI, lower HDL-C level and higher CRP level were found to be closely associated with uCAD, independent of confounding variables. The findings for the new dialysis patients without cardiac disease were similar. Conclusions: The prevalence of uCAD in patients with end-stage kidney disease has remarkably decreased over the past two decades. Major improvements in the medical management of CKD may modify the prevalence of coronary atherosclerosis. J Atheroscler Thromb, 2014; 21:593-604.

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Section: Discussionmentioning

confidence: 99%

Declining Prevalence of Coronary Artery Disease in Incident Dialysis Patients Over the Past Two Decades

Iwasaki

Joki

Tanaka

et al. 2014

JAT

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“…With dipyridamole thallium myocardial scintigraphy, Nes-to et al [32] reported a high prevalence (57 %) of thallium defects in diabetic patients with peripheral vascular disease, but they also did not include systematic coronary angiography. Boudreau et al [13] who studied diabetic patients with end-stage renal failure, reported sensitivity, specificity and accuracy of about 85 % for dipyridamole thallium myocardial scintigraphy, the prevalence of CAD in these patients being 53 %. Myocardial thallium scintigraphy may given false-positive results in patients with valvular heart disease, or with left bundle branch block, who were excluded from our study.…”

Section: Discussionmentioning

confidence: 99%

“…In diabetic patients, the sensitivity and specificity of the non-invasive tests for detection of CAD are poorly known. Only a few studies have included subjects undergoing coronary angiography and concerned special groups of diabetic patients [13].…”

mentioning

confidence: 99%

Detection of coronary artery disease in diabetic patients

et al. 1995

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SummaryCoronary artery disease may be difficult to detect in diabetic patients. This study was designed to determine the specificity and sensitivity of three noninvasive tests. Accordingly, the results of 48-h ambulatory electrocardiogram (ECG) monitoring, maximal ECG exercise test, and intravenous dipyridamole myocardial thallium scintigraphy were compared in 59 middle-aged diabetic patients who were consecutively selected for suspected coronary artery disease. All patients also underwent coronary angiography, which was performed regardless of the results of the non-invasive tests. Twenty patients (34 %) had significant coronary lesions, i.e. stenosis equal to or greater than 70 %, and 16 of these 20 patients (80 %) had double or triple vessel disease. Sensitivity and specificity were, respectively, 25 % and 88 % for ambulatory ECG monitoring, 75 % and 77 % for the exercise test and 80 % and 87 % for thallium myocardial scintigraphy. This observation strongly supports the use of non-invasive tests for the detection of coronary artery disease in those diabetic patients at high risk of such disease. As the exercise test is cheaper and more widely available than thallium myocardial scintigraphy it should be used as a first line examination. Dipyridamole myocardial scintigraphy may provide an alternative solution for those patients who cannot perform maximal exercise, or with atypical clinical presentation. [Diabetologia (1995) 38: 726-731] Key words Non-invasive test, detection, coronary artery disease, diabetic patients.Large epidemiological prospective studies have shown that coronary artery disease (CAD) is the main cause of morbidity and death in patients with diabetes mellitus [1][2][3]. Recently, the Multiple Risk Factor Intervention Trial (MRFIT) [4] reported that the mortality rate for CAD and cardiovascular disease was three times higher in diabetic men than in non-diabetic men. Furthermore, a significant independent association between diabetes and cardiovascular mortality was definitively demonstrated in this trial.

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“…In one well designed, prospective study, dipyridamole thallium scintigraphy was performed in 80 diabetic patients being evaluated for renal transplantation (687). Results were compared to quantitative angiography using lesions of at least 70% occlusion to define coronary artery disease.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

2001

American Journal of Transplantation

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Perfusion thallium imaging of type I diabetes patients with end stage renal disease: comparison of oral and intravenous dipyridamole administration.

Cited by 82 publications

References 0 publications

Declining Prevalence of Coronary Artery Disease in Incident Dialysis Patients Over the Past Two Decades

Declining Prevalence of Coronary Artery Disease in Incident Dialysis Patients Over the Past Two Decades

Detection of coronary artery disease in diabetic patients

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

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