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Effects of chronic kidney disease on myocardial washout rate of thallium-201 in patients with normal myocardial perfusion on single photon emission computed tomography

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Abstract

Background

Myocardial perfusion single photon emission computed tomography (SPECT) is often performed even in patients with chronic kidney disease (CKD). We assessed the effects of CKD on myocardial washout rate (WR) of thallium (Tl)-201 in patients with normal myocardial perfusion on SPECT.

Methods

Two hundred and fifty-six patients with normal myocardial perfusion were enrolled in this study. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Patients with eGFR ≥ 60 ml/min/1.73 m2 were assigned to a control group. The mean myocardial WR of Tl-201 was calculated from the stress and the redistribution Bull’s eye maps.

Results

With progressive CKD stages, systolic blood pressure and incindence of hypertension were increased. All patients in CKD stage 5 group were being treated with hemodialysis. Myocardial WR of Tl-201 was significantly higher in all of the CKD groups than control group. With progressive CKD stages, myocardial WR of Tl-201 was increased (stage 3, 52.2 ± 9.2%; stage 4, 55.5 ± 8.1%; and stage 5, 58.9 ± 5.6%). Multivariate analysis showed that hemoglobin (β = −0.24, p < 0.001) and eGFR (β = −0.24, p = 0.002) were the major determinants of myocardial WR of Tl-201, but hemodialysis was not.

Conclusions

Our data suggest that CKD is associated with increased myocardial WR of Tl-201 in patients with normal perfusion on SPECT.

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References

  1. Patel CD, Nadig MR, Kurien S, Barai S, Narang R, Malhotra A. Left ventricular ejection fraction and volumes on rest gated 201Tl perfusion SPECT: comparison with two-dimensional echocardiography. Nucl Med Commun. 2006;27:425–9.

    Article  PubMed  Google Scholar 

  2. Kurisu S, Iwasaki T, Ikenaga H, Watanabe N, Higaki T, Shimonaga T, et al. Influence of left ventricular geometry on thallium-201 gated single-photon emission tomographic findings in patients with known or suspected coronary artery disease. Ann Nucl Med. 2014;28:120–7.

    Article  PubMed  Google Scholar 

  3. Kurisu S, Iwasaki T, Abe N, Tamura M, Ikenaga H, Watanabe N, et al. Effects of myocardial perfusion abnormalities on the accuracy of left ventricular volume and ejection fraction measured by thallium-201 gated single-photon emission tomography: comparison with echocardiography as the reference standard. Nucl Med Commun. 2015;36:1127–33.

    Article  CAS  PubMed  Google Scholar 

  4. Kurisu S, Sumimoto Y, Ikenaga H, Watanabe N, Ishibashi K, Dohi Y, Hidaka T, Fukuda Y, Kihara Y. Effects of left ventricular size on the accuracy of diastolic parameters derived from myocardial perfusion SPECT: comparison with tissue Doppler echocardiography. Ann Nucl Med. 2016;30:645–51.

    Article  PubMed  Google Scholar 

  5. Lee J, Chae SC, Lee K, Heo J, Iskandrian AS. Biokinetics of thallium-201 in normal subjects: comparison between adenosine, dipyridamole, dobutamine and exercise. J Nucl Med. 1994;35:535–41.

    CAS  PubMed  Google Scholar 

  6. Angello DA, Wilson RA, Gee D. Effect of ribose on thallium-201 myocardial redistribution. J Nucl Med. 1988;29:1943–50.

    CAS  PubMed  Google Scholar 

  7. Bateman TM, Maddahi J, Gray RJ, Murphy FL, Garcia EV, Conklin CM, et al. Diffuse slow washout of myocardial thallium-201: a new scintigraphic indicator of extensive coronary artery disease. J Am Coll Cardiol. 1984;4:55–64.

    Article  CAS  PubMed  Google Scholar 

  8. Maddahi J, Abdulla A, Garcia EV, Swan HJ, Berman DS. Noninvasive identification of left main and triple vessel coronary artery disease: improved accuracy using quantitative analysis of regional myocardial stress distribution and washout of thallium-201. J Am Coll Cardiol. 1986;7:53–60.

    Article  CAS  PubMed  Google Scholar 

  9. Furuhashi T, Moroi M, Joki N, Hase H, Masai H, Kunimasa T, Nakazato R, Fukuda H, Sugi K. Impact of chronic kidney disease and stress myocardial perfusion imaging as a predictor of cardiovascular events. Ann Nucl Med. 2011;25:616–24.

    Article  PubMed  Google Scholar 

  10. Dahan M, Viron BM, Faraggi M, Himbert DL, Lagallicier BJ, Kolta AM, Pessione F, Le Guludec D, Gourgon R, Mignon FE. Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients. Kidney Int. 1998;54:255–62.

    Article  CAS  PubMed  Google Scholar 

  11. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Collaborators developing the Japanese equation for estimated GFR: revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  PubMed  Google Scholar 

  12. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1–266.

    Google Scholar 

  13. Kinoshita N, Sugihara H, Adachi Y, Nakamura T, Azuma A, Kohno Y, Nakagawa M. Assessment of transient left ventricular dilatation on rest and exercise on Tc-99m tetrofosmin myocardial SPECT. Clin Nucl Med. 2002;27:34–9.

    Article  PubMed  Google Scholar 

  14. Abidov A, Bax JJ, Hayes SW, Cohen I, Nishina H, Yoda S, Kang X, Aboul-Enein F, Gerlach J, Friedman JD, Hachamovitch R, Germano G, Berman DS. Integration of automatically measured transient ischemic dilation ratio into interpretation of adenosine stress myocardial perfusion SPECT for detection of severe and extensive CAD. J Nucl Med. 2004;45:1999–2007.

    CAS  PubMed  Google Scholar 

  15. Fukuda H, Moroi M. Prediction of cardiac events in patients with transient left ventricle dilation on stress myocardial perfusion SPECT images. Circ J. 2005;69:1223–9.

    Article  PubMed  Google Scholar 

  16. Komori H. Effects of metabolic and myocardial microcirculatory abnormalities on the pathogenesis of cardiac autonomic neuropathy in type 2 diabetes mellitus: a prospective study in Japanese patients. Curr Ther Res Clin Exp. 2005;66:600–12.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Matsuo S, Nakajima K, Onoguchi M, Wakabayash H, Okuda K, Kinuya S. Nuclear myocardial perfusion imaging using thallium-201 with a novel multifocal collimator SPECT/CT: IQ-SPECT versus conventional protocols in normal subjects. Ann Nucl Med. 2015;29:452–9.

    Article  PubMed  Google Scholar 

  18. Kincl V, Kamínek M, Vašina J, Panovský R, Havel M. Feasibility of ultra low-dose thallium stress-redistribution protocol including prone imaging in obese patients using CZT camera. Int J Cardiovasc Imaging. 2016;32:1463–9.

    Article  PubMed  Google Scholar 

  19. Ozkok S, Ozkok A. Contrast-induced acute kidney injury: a review of practical points. World J Nephrol. 2017;6:86–99.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ragosta M, Samady H, Isaacs RB, Gimple LW, Sarembock IJ, Powers ER. Coronary flow reserve abnormalities in patients with diabetes mellitus who have end-stage renal disease and normal epicardial coronary arteries. Am Heart J. 2004;147:1017–23.

    Article  PubMed  Google Scholar 

  21. Koivuviita N, Tertti R, Järvisalo M, Pietilä M, Hannukainen J, Sundell J, Nuutila P, Knuuti J, Metsärinne K. Increased basal myocardial perfusion in patients with chronic kidney disease without symptomatic coronary artery disease. Nephrol Dial Transpl. 2009;24:2773–9.

    Article  Google Scholar 

  22. Charytan DM, Shelbert HR, Di Carli MF. Coronary microvascular function in early chronic kidney disease. Circ Cardiovasc Imaging. 2010;3:663–71.

    Article  PubMed  Google Scholar 

  23. Fukushima K, Javadi MS, Higuchi T, Bravo PE, Chien D, Lautamäki R, Merrill J, Nekolla SG, Bengel FM. Impaired global myocardial flow dynamics despite normal left ventricular function and regional perfusion in chronic kidney disease: a quantitative analysis of clinical 82Rb PET/CT studies. J Nucl Med. 2012;53:887–93.

    Article  PubMed  Google Scholar 

  24. Welch HF, Strauss HW, Pitt B. The extraction of thallium-201 by the myocardium. Circulation. 1977;56:188–91.

    Article  Google Scholar 

  25. Marshall RC, Leidholdt EM Jr, Zhang DY, Barnett CA. The effect of flow on technetium-99m-teboroxime (SQ30217) and thallium-201 extraction and retention in rabbit heart. J Nucl Med. 1991;32:1979–88.

    CAS  PubMed  Google Scholar 

  26. Vonend O, Rump LC, Ritz E. Sympathetic overactivity: the Cinderella of cardiovascular risk factors in dialysis patients. Semin Dial. 2008;21:326–30.

    Article  PubMed  Google Scholar 

  27. Schlaich MP, Socratous F, Hennebry S, Eikelis N, Lambert EA, Straznicky N, Esler MD, Lambert GW. Sympathetic activation in chronic renal failure. J Am Soc Nephrol. 2009;20:933–9.

    Article  PubMed  Google Scholar 

  28. Kurisu S, Sumimoto Y, Ikenaga H, Watanabe N, Ishibashi K, Dohi Y, Fukuda Y, Kihara Y. Effects of hemoglobin level on myocardial washout rate of thallium-201 in patients with normal myocardial perfusion assessed by single-photon emission computed tomography. Heart Vessels. 2017;32:1062–6.

    Article  Google Scholar 

  29. MacRae JM, Levin A, Belenkie I. The cardiovascular effects of arteriovenous fistulas in chronic kidney disease: a cause for concern? Semin Dial. 2006;19:349–52.

    Article  PubMed  Google Scholar 

  30. Takata J, Counihan PJ, Gane JN, Doi Y, Chikamori T, Ozawa T, McKenna WJ. Regional thallium-201 washout and myocardial hypertrophy in hypertrophic cardiomyopathy and its relation to exertional chest pain. Am J Cardiol. 1993;72:211–7.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Nobukazu Abe and Megumi Tamura for their excellent technical assistance.

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Correspondence to Satoshi Kurisu.

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Kurisu, S., Sumimoto, Y., Ikenaga, H. et al. Effects of chronic kidney disease on myocardial washout rate of thallium-201 in patients with normal myocardial perfusion on single photon emission computed tomography. Ann Nucl Med 31, 703–708 (2017). https://doi.org/10.1007/s12149-017-1204-1

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  • DOI: https://doi.org/10.1007/s12149-017-1204-1

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