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Myocardial SPECT Images in Incident Hemodialysis Patients Without Ischemic Heart Disease
Author(s) -
KoyamaNakamura Mari,
Mizobuchi Masahide,
Kaneko Kyoichi,
Watanabe Makoto,
Ogata Hiroaki,
Koiwa Fumihiko,
Akizawa Tadao,
Akutsu Yasushi,
Shibata Takanori
Publication year - 2015
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.12320
Subject(s) - medicine , cardiology , dialysis , coronary artery disease , heart failure , myocardial perfusion imaging , kidney disease , perfusion
Cardiovascular disease is the leading cause of death in dialysis patients and is significantly associated with poor survival in incident dialysis patients. However, little is known about the pathogenesis of cardiovascular disease in these populations. 123 I ‐15‐(p‐iodophenyl)‐3( R , S )‐ methylpentadecanoic acid ( BMIPP ) imaging is useful for detection of ischemic heart disease. We examined imaging characteristics to identify potential pathologies of cardiac disease, other than ischemic heart disease. The subjects were 42 incident dialysis patients without histories of ischemic heart disease such as acute coronary syndrome. All the patients underwent BMIPP imaging in addition to a screening examination. Patients with positive findings in BMIPP imaging underwent myocardial perfusion imaging within 2 weeks after BMIPP imaging to evaluate the possibility of ischemic heart disease. Twenty‐two patients were BMIPP ‐positive and 10 of these patients had negative findings on perfusion imaging and were defined as mismatch cases. Compared with patients who were BMIPP ‐ and perfusion‐positive, the mismatch cases had higher parathyroid hormone ( PTH ), serum albumin, and alkaline phosphatase levels. The mismatch cases also formed the largest proportion in the highest PTH tertile. A histologic examination of a mismatch case with no stenotic lesions in the coronary artery revealed the presence of cardiac hypertrophy and fibrosis. These findings suggest that a perfusion‐metabolism mismatch may be present in incident dialysis patients without a history of ischemic heart disease. This mismatch is associated with PTH, which suggests potential involvement of uremic cardiomyopathy in the pathology of cardiac disease in these patients.