Camp A D, Garvin P J, Hoff J, Marsh J, Byers S L, Chaitman B R
Department of Internal Medicine, St. Louis University School of Medicine, Missouri.
Am J Cardiol. 1990 Jun 15;65(22):1459-63. doi: 10.1016/0002-9149(90)91355-a.
Patients with diabetes and end-stage renal failure are known to have a high risk for cardiac morbidity and mortality associated with renal transplantation. The most efficient method to determine preoperative cardiac risk has not been established. To determine the effectiveness of intravenous dipyridamole thallium imaging in predicting cardiac events, 40 diabetic renal transplant candidates were studied preoperatively in a prospective trial. The study group consisted of 40 patients whose average age was 42 years (range 27 to 64); 34 (85%) were hypertensive and 21 (53%) were cigarette smokers. Cardiac history included chest pain in 6 patients and prior myocardial infarction in 3 patients. Dipyridamole thallium imaging showed reversible defects in 9 patients, fixed defects in 8 patients and normal scans in 23 patients. Dipyridamole thallium imaging was performed using 0.56 mg/kg of dipyridamole infused intravenously over 4 minutes. Cardiac events occurred only in patients with reversible thallium defects, of which there were 6. Of these 6 patients, 3 had cardiac events before transplantation and 3 had them in the early postoperative phase (within 6 weeks of surgery). Of 21 patients who underwent renal transplantation, 3 had cardiac events within 6 weeks of transplantation. The average duration of follow-up was 11 months (range 1 to 21). Thus, dipyridamole thallium imaging is an effective method of identifying renal transplant candidates likely to develop cardiac complications. Routine coronary angiography may not be necessary to screen all renal transplant candidates for coronary artery disease before surgery.
已知糖尿病和终末期肾衰竭患者在肾移植后发生心脏发病和死亡的风险很高。尚未确立确定术前心脏风险的最有效方法。为了确定静脉注射双嘧达莫心肌灌注显像预测心脏事件的有效性，在一项前瞻性试验中对40名糖尿病肾移植候选者进行了术前研究。研究组由40名患者组成，平均年龄为42岁（范围27至64岁）；34名（85%）患有高血压，21名（53%）吸烟。心脏病史包括6名患者有胸痛，3名患者曾有心肌梗死。双嘧达莫心肌灌注显像显示9名患者有可逆性缺损，8名患者有固定性缺损，23名患者扫描正常。双嘧达莫心肌灌注显像采用0.56mg/kg双嘧达莫静脉注射4分钟。心脏事件仅发生在有可逆性铊缺损的患者中，共有6名。在这6名患者中，3名在移植前发生心脏事件，3名在术后早期（手术6周内）发生。在接受肾移植的21名患者中，3名在移植后6周内发生心脏事件。平均随访时间为11个月（范围1至21个月）。因此，双嘧达莫心肌灌注显像是识别可能发生心脏并发症的肾移植候选者的有效方法。术前对所有肾移植候选者进行冠状动脉疾病筛查可能无需常规冠状动脉造影。
