Influence of diabetes mellitus on diagnostic potential of iodine-123-BMIPP imaging for coronary artery stenosis in hemodialysis patients.
BACKGROUND
Single-photon emission computed tomography (SPECT) using a fatty acid analogue, iodine-123-beta-methyl iodophenyl-pentadecanoic acid (123I-BMIPP), as a tracer may be effective for detecting coronary artery disease in end-stage renal disease (ESRD) patients. In this study, we investigated whether the presence of diabetes mellitus may affect the diagnostic potential of BMIPP SPECT for detecting coronary stenosis in ESRD patients.


METHODS
123I-BMIPP SPECT was performed in 98 diabetic hemodialysis patients (male to female ratio 66:32; mean age 63.6+/-9.8 years) and 103 nondiabetic hemodialysis patients (68:35; 64.5+/-10.4 years), followed by coronary angiography within 60 days of the SPECT. SPECT imaging was evaluated and graded on a 5-point scale (0=normal, 4=absence of tracer) and assessed as a BMIPP summed score for 17 left ventricular segments.


RESULTS
Coronary angiography revealed that 72.4% (71/98) of the diabetic patients and 56.3% (58/103) of the non-diabetic patients had significant coronary stenosis more than 50%; incidences of asymptomatic coronary stenosis were 77.5% in diabetic patients and 72.4% in nondiabetic patients. When a BMIPP summed score of 8 or more was defined as abnormal, sensitivity, specificity and accuracy for detecting coronary stenosis by BMIPP SPECT were 97.2, 63.0 and 87.8% in diabetic patients, and 96.6, 73.3 and 86.4% in nondiabetic patients. In receiver operating characteristic analysis, the areas under the curve of BMIPP SPECT to diagnose coronary stenosis were 0.897 in diabetic and 0.906 in nondiabetic patients.


CONCLUSIONS
BMIPP SPECT seems to be able to detect coronary stenosis in diabetic as well as nondiabetic hemodialysis patients.
Nishimura
Masato
M
Cardiovascular Division, Toujinkai Hospital, Kyoto, and Department of Clinical Sciences and Laboratory Medicine, Kansai Medical University, Hirakata, Japan. mnishimura@tea.ocn.ne.jp
Murase
Masaki
M
Hashimoto
Tetsuya
T
Kobayashi
Hiroyuki
H
Yamazaki
Satoru
S
Imai
Ryo
R
Okino
Koji
K
Fujita
Hiroshi
H
Inoue
Naoto
N
Takahashi
Hakuo
H
Ono
Toshihiko
T
D000255:Adenosine Triphosphate / Q000096:biosynthesis; D000368:Aged; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003920:Diabetes Mellitus / Q000378:metabolism*; D004562:Electrocardiography; D005227:Fatty Acids; D005260:Female; D006461:Hemolysis; D006801:Humans; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon
D005227:Fatty Acids; D007457:Iodine Radioisotopes; D007462:Iodobenzenes; C049338:iodofiltic acid; D000255:Adenosine Triphosphate