ABSTRACT
Background: The implications of cardiac risk stratification before orthotopic liver transplantation [OLT] are not well established. We studied the usefulness of myocardial perfusion imaging [MPI] in this scenario
Methods: MPI data of 24 patients [9 females], candidates of OLT, were collected. They underwent MPI as part of their preoperative risk assessment. MPIs were interpreted by 2 nuclear physicians, who had access to clinical data, scan, and semi-quantification results [i.e., quantitative perfusion single-photon emission tomography [SPECT] [QPS] and quantitative gated SPECT [QGS]]. A 3rd nuclear physician, blinded to the clinical history of the subjects, re-reviewed the scans. The visual interpretations of MPI [i.e., normal vs. abnormal], ejection fraction, and transient ischemic dilation index derived from QPS and clinical and follow-up data were collected and analyzed
Results: The follow-up period was 231.0 +/- 86.0 days. The MPIs were normal in 16 [66.7%] patients and abnormal in 8 [i.e., 5 mild [20.8%], 1 [4.2%] moderate, and 2 [8.3%] severe]. Out of 4 patients who died during the follow-up, 1 had mild ischemia and 2 had severe ischemia. A patient who had a normal MPI died due to noncardiac reasons. A patient with abnormal MPI had 3-vessel disease on angiography. Out of the 5 patients who died or had significant coronary angiographic abnormalities, 4 had abnormal MPIs [negative predictive value = 93.8%; sensitivity = 80.0%] The MPIs of 4 patients withoutperioperative mortality or cardiac morbidity were abnormal [specificity = 78.9%]
Conclusion: MPI seems to be remarkable in discriminating high-risk OLT patients preoperatively
ABSTRACT
We intended to assess the accuracy of re-expressed Modification of Diet for Renal Disease [MDRD] and Cockcroft-Gault [CG] equations to estimate glomerular filtration rate [GFR] in chronic kidney disease in two different etiologies of acute renal failure [ARF]: acute tubular necrosis [ATN] and acute glomerulonephritis [AGN]. Patients admitted for ARF or the patients complicated with ARF during the course of their hospitalization were enrolled to the study [n=21; 14 females and 7 males; 11 ATN and 12 AGN]. When the plasma creatinine reached a steady state [DPSM] using [99m]Tc-DTPA. GFR was also estimated by MDRD [GFRMDRD] and CG [GFRCG] equations. The patients aged 44.8 +/- 19.5 years and weighted 67.8 +/- 10.7kg. GFRDPSM [32.9 +/- 14.7 ml/min] was statistically different from the GFRMDRD [11.6 +/- 8.2 ml/min; pCG was lower than GFRDPSM in patients with either ATN [16.5 +/- 12.5ml/min and pDPSM and GFRMDRD [r=0.34; p=0.13] but GFRDPSM and GFRCG values were correlated [r=0.48; p=0.03]. Out of subjects with GFRDPSM >30, 92.3% had GFRMDRDCG Our results indicate that MDRD and CG equations were substantially inaccurate in patients with ARF. More precise methods of GFR evaluation is recommended in these patients
ABSTRACT
The liver plays a main role in the production and metabolism of lipoproteins, and then impaired lipid metabolism is often seen in patients with liver cirrhosis and chronic hepatitis [CH]. As a result, plasma lipid levels could be as useful indicators of liver function and patient's prognosis especially in liver cirrhosis. We measured the lipoprotein levels in 77 consecutive patients with liver cirrhosis and CH. 47 men [61%] and 30 women [39%] with mean age 43years [SD=16.4] and mean BMI 26[SD=4.2] have been recruited as patients group. Child score and MELD scale was determined in patients group. The control group was age and sex matched with patients group. In case group, the levels of HDL LDL, TG, and total cholesterol were significantly lower than control group [p <0.0001]. In patients with cirrhosis, the levels of LDL, HDL and total cholesterol were progressively lower when comparing patients in Child class A with patients in class C [p<0.0001].This difference was more significant in LDL and total cholesterol and between upper Child scores similarly decreasing in LDL, HDL, and total cholesterol level was observed when MELD score increased [P<0.0001]. There is a correlation between plasma lipid levels and liver function, so it may be mentioned as an accessible and reliable indicator of liver function in cirrhotic and CH patients