Detection of undiagnosed ischemic heart disease in hemodialysis patients using myocardial perfusion imaging

Abstract

Background: Coronary artery disease (CAD) is prevalent but very difficult to diagnose in hemodialysis (HD) patients compared with nonuremic individuals. Objectives: The aim of this study was to detect undiagnosed ischemic heart disease (IHD) using dipyridamole myocardial perfusion imaging (MPI) in HD patients. Patients and Methods: In this cross-sectional descriptive study, HD patients who met the inclusion criteria were selected. Demographic, clinical, and paraclinical data were obtained via interviews and medical records. Bedside electrocardiography, resting echocardiography, and nuclear MPI with dipyridamole were done. The data were analyzed using descriptive statistical methods for detecting the prevalence of undiagnosed IHD in the HD patients. The chi-square test and the independent t-test were used to identify the high-risk HD patients. Results: Sixty-nine HD patients were studied using dipyridamole MPI with Tc 99 m sestamibi. The mean age, body mass index, and mean duration of HD were 52.1 ± 13.8 years, 21.23 ± 4.79 kg/m2, and 48.2 ± 34.9 months, respectively. The patients were divided into two groups based on MPI: IHD-positive group (21.7%) and IHD-negative group (78.3%). IHD was more prevalent in the patients with diabetes mellitus, hypertension, positive family history of CAD, low HD adequacy index (Kt/V < 1.2), left ventricular hypertrophy, high intact parathyroid hormone levels, electrocardiographic abnormalities, and low ferritin levels. A statistically significant correlation was also detected between IHD and aging (P < 0.05). Conclusions: The prevalence of undiagnosed IHD in the HD patients was considerable. We, therefore, suggest that IHD be assessed in HD patients, especially those at high risk due to positive family history of CAD, hypertension, left ventricular hypertrophy, diabetes mellitus, Kt/V < 1.2, low ferritin levels, and high levels of intact parathyroid hormone.