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