Myocardial perfusion and ventricular function assessed by SPECT and Gated-SPECT in end-stage renal disease patients before and after renal transplant.
BACKGROUND
Cardiovascular disease is a major cause of morbidity and mortality in end-stage renal disease (ESRD). Renal transplant is known to improve left ventricle hypertrophy and systolic dysfunction in selected groups of patients.


METHODS
We assessed myocardial perfusion, wall motion and functional parameters by single photon emission computed tomography (SPECT) and Gated-SPECT in 30 consecutive ESRD patients with normal coronary angiograms before and after renal transplantation.


RESULTS
Uremic cardiomyopathy improved significantly after the transplant. The proportion of patients with angina decreased from 26 to 0%; the frequency of cardiomegaly decreased from 57 to 20% (p <0.01); the frequency of segments with perfusion defects decreased from 42.7 to 10.2% (p <0.001); the proportion of patients with low left ventricular ejection fraction (LVEF) dropped from 53.3 to 20% (p <0.001); and mean LVEF increased from (48.0 +/- 9.7% to 58.2 +/- 8.2%). Similarly, the proportion of segments showing systolic wall thickening, hypokinesia and dyskinesia also decreased significantly after renal transplant (p <0.01).


CONCLUSIONS
Uremic cardiomyopathy may be potentially reversible in patients with normal angiographic coronary arteries after renal transplant in a relatively short period of time. SPECT and Gated-SPECT are objective gateway methods to determine myocardial perfusion, hypokinesia, dyskinesia, and functional parameters (left ventricular ejection fraction and systolic wall thickening) and may be useful to establish diagnostic, coronariographic, prognostic, and therapeutic indications.
Bialostozky
David
D
Servicio de Cardiología Nuclear, Instituto Nacional de Cardiología Ignacio Chavez, México, DF, México.
Leyva
Mayela
M
Villarreal
Teresa
T
Casanova
J Miguel
JM
Pérez-Grovas
Héctor
H
Lemus
Patricia
P
Jiménez
Guadalupe
G
Vallejo
Enrique
E
Jiménez-Angeles
Luis
L
Herrera
Jaime
J
Altamirano
Javier
J
D000293:Adolescent; D000328:Adult; D003326:Coronary Circulation; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016277:Ventricular Function, Left