technetium-tc-99m-tetrofosmin and Kidney-Failure--Chronic

Patients with chronic kidney disease (CKD) have worse cardiovascular outcomes. The prognostic value of the new pharmacological stressor regadenoson (REG) in patients with varying levels of kidney function is not known (REG-SPECT). Furthermore, the impact of varying levels of kidney dysfunction on cardiac outcomes in patients undergoing REG-SPECT has not been defined. Our objective was to evaluate the prognostic value of regadenoson stress imaging in patients with different levels of kidney dysfunction.. We followed 1107 consecutive patients who underwent REG-SPECT for a mean duration of 1.8 ± 0.8 years. CKD was defined as estimated glomerular filtration rate (GFR) 60 mL/min/1.73 m(2). Kaplan-Meier survival analysis was performed to evaluate survival, free of major adverse cardiac events (MACE). CKD patients with GFR <60 (47% male, mean age 70 years) had a higher prevalence of cardiac risk factors and a history of coronary artery disease and were on significantly more cardiac medications (P < 0.001) than those with GFR >60. Patients with GFR <60 were significantly more likely to develop adverse cardiac outcomes including congestive heart failure (CHF) (P = 0.02), cardiac death (P < 0.001), all-cause death (P < 0.001), and MACE (P < 0.001) over the period of follow-up. Cardiac death increased with worsening levels of perfusion defects (SSS) across the entire spectrum of renal function (P < 0.001). GFR <60 was an independent predictor of MACE with a hazard ratio (HR) of 1.49 (95% CI: 1.06-2.08). The presence of transient ischaemic dilation (TID) was associated with an HR of 5.06 (95% CI: 1.43-17.90).. Renal function is a powerful risk predictor in patients undergoing REG-SPECT. REG-SPECT provides robust prognostication across the entire spectrum of renal function.

Topics: Adenosine A2 Receptor Agonists; Aged; Biomarkers; Cardiovascular Diseases; Electrocardiography; Endpoint Determination; Female; Humans; Kidney Failure, Chronic; Kidney Function Tests; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Purines; Pyrazoles; Radiopharmaceuticals; Risk Factors; Survival Rate; Tomography, Emission-Computed, Single-Photon

Topics: Adenosine A2 Receptor Agonists; Cardiovascular Diseases; Female; Humans; Kidney Failure, Chronic; Male; Organophosphorus Compounds; Organotechnetium Compounds; Purines; Pyrazoles; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Diagnosis, Differential; Female; Hernia, Hiatal; Humans; Ischemia; Kidney Failure, Chronic; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Uncertainty remains as to the most appropriate preoperative screening investigation to evaluate patient cardiac risk in prospective renal transplant recipients. We prospectively compared tachycardic-stress (exercise/pacing) scintigraphy with coronary angiography for the detection of significant coronary artery disease in this group. With a negative predictive value of 92%, tachycardic-stress scintigraphy may reduce the need for unnecessary coronary angiography in these patients.

Topics: Coronary Angiography; Coronary Disease; Exercise Test; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Risk Assessment; Sensitivity and Specificity

The aim of the work was to study the diagnostic value of Tc-99m tetrofosmin to localize anomalous parathyroid glands in patients with hyperparathyroid disease.. We studied 31 patients, 19 with primary and 12 with secondary hyperparathyroid disease. Five of these patients were renal graft recipients. All patients underwent surgery. Each patient was injected with 555 to 740 MBq (15 to 20 mCi) Tc-99m tetrofosmin. Subsequently, radionuclide images were acquired 15 and 120 minutes after injection using a low-energy, all-purpose, parallel-hole collimator. Pertechnetate thyroid scintigraphy was obtained in nine cases (24 to 48 h later) when the thyroid activity made it difficult to identify the parathyroid glands.. All cases showed tracer uptake as early as 15 minutes after injection. In the group of patients with primary hyperparathyroid disease, 15 showed focal uptake in a parathyroid gland, and surgery revealed an adenoma in the same location. In one patient with hyperplasia, scintigraphy identified only two of four diseased glands. In the three remaining cases, scintigraphy showed focal uptake in the lower parathyroid gland, whereas at surgery the abnormal gland was located in the upper pole. In the secondary hyperparathyroidism group, seven patients showed diffuse tracer uptake in two or more glands, and histologic analysis confirmed hyperplasia in all of them. Five cases showed focal uptake, with three evaluated after surgery (uptake in the only remaining gland); one of them was a renal graft recipient, and the remaining patient had chronic renal failure and was receiving hemodialysis.. Our results suggest that Tc-99m tetrofosmin may be a suitable tracer for preoperative detection and screening of anomalous parathyroid glands. The earlier images at 15 minutes were better than those at 120 minutes. Tc-99m tetrofosmin is cleared more slowly from the normal thyroid than is Tc-99m sestamibi, and both of these tracers may give better results than the old pertechnetate TI-201 subtraction technique.

Topics: Adenoma; Adult; Aged; Evaluation Studies as Topic; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Hyperplasia; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Gland; Time Factors

The aim of the work was to study the diagnostic value of 99mTc-tetrofosmin to localize anomalous parathyroid glands in patients with hyperparathyroidism.. We have studied 33 patients: 12 with primary and 21 with secondary hyperparathyroidism, 9 of them renal graft recipients. Sixteen patients underwent surgery, 12 with primary and 4 with secondary hyperparathyroidism. All patients were injected with 740 MBq of 99mTc-tetrofosmin. Subsequently at 15, 30 and 60 minutes images were acquired for 300 seconds using a pin-hole collimator. A pertechnetate thyroid scintigraphy was obtained in 7 cases (24-48 h later) when the thyroid activity made difficult the identification of parathyroid glands.. In the group of patients with primary hyperparathyroidism, all cases showed a focal uptake in lower right localization. In the secondary hyperparathyroidism group, 12 patients showed diffuse tracer uptake in two or more glands and histology confirmed hyperplasia in four of them. Seven cases showed a greater focal uptake in a gland: two of them were renal graft recipients and three were chronic renal failure cases in haemodyalisis, and two were evaluated postsurgery showing uptake in the remnant parathyroid gland. The two remaining patients had a normal scintigraphy and corresponded to two false negative cases. In conclusion, our results suggest that 99Tc-tetrofosmin may be used as a suitable tracer for preoperative detection and screening of anomalous parathyroid glands.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Hyperplasia; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Glands; Parathyroid Neoplasms; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Thyroid Gland