[Radionuclide studies in chronically hemodialyzed patients. Diagnosis of coronary disease using Tl-201 myocardial scintigraphy after administration of dipyridamole].
Myocardial perfusion using Tl 201 after dipyridamol was evaluated in 33 patients on maintenance hemodialysis. In addition radionuclide angiography (RNA) was performed following hemodialysis to assess left ventricular function. RNA was done at rest in 31 patients and repeated in 13 after isometric exercise. All patients studied showed no signs of congestive heart failure. 55% of the patients had abnormal Tl 201 scintigrams, whereas coronary artery disease (CAD) was underestimated from clinical symptoms alone (33%). The incidence of an abnormal Tl 201 finding increased with the duration of hemodialysis treatment. However, in the symptomatic patients angina appeared already in the first (45%) or second year of hemodialysis treatment. 39% of patients with abnormal Tl 201 findings died within a year following scintigraphic examination. From 15 patients with normal Tl 201 scans 26% died. Overall mortality rate was above that in asymptomatic or mildly symptomatic patients with CAD, averaging about 7.7% per day. The major causes of death were cardiovascular complications in patients with abnormal Tl 201 findings. In all patients left ventricular ejection fraction (LVEF) was within the normal range following hemodialysis. Thus in our patients LVEF appeared not as an important prognostic characteristic. However, ventricular function can be impaired following exercise. As expected, in 7 patients with CAD (abnormal Tl 201 scan) isometric handgrip induced a mean decrease in LVEF by 11% and abnormalities in regional wall motion. However, also in 4 of 6 patients with normal Tl 201 scintigrams LVEF decreased following isometric exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004176:Dipyridamole / Q000627:therapeutic use*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D006951:Hyperlipoproteinemias / Q000209:etiology; D006977:Hypertension, Renal / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D011868:Radioisotopes; D011877:Radionuclide Imaging; D006435:Renal Dialysis; D013318:Stroke Volume; D013793:Thallium
D011868:Radioisotopes; D004176:Dipyridamole; D013793:Thallium
Nuklearmedizinische Untersuchungen bei chronisch hämodialysierten Patienten. Diagnostik der koronaren Herzkrankheit mittels Tl-201-Myokardszintigraphie nach Dipyridamol.