AI Article Synopsis
- Screening for coronary artery disease (CAD) in patients on hemodialysis faces challenges due to limitations of testing methods, particularly myocardial perfusion scintigraphy (MPS) with dipyridamole.
- A study comparing MPS results from dipyridamole and dobutamine in 121 hemodialysis patients revealed that dobutamine induced more significant ischemic lesions, particularly in the anteroseptal regions.
- However, dipyridamole MPS was found to better predict risk for cardiac death and non-fatal CAD, suggesting that while dobutamine shows more intense results, it may create misleading conclusions about patient risk.
Article Abstract
Screening for coronary artery disease (CAD) in hemodialysis patients is hampered by contraindications and/or limitations of the available techniques in this population. Myocardial perfusion scintigraphy (MPS) using dipyridamole has been considered inaccurate due to abnormally high basal levels of adenosine in uremia that could blunt the vasodilatory response. Since dobutamine may be more reliable, we directly compared the two in patients on hemodialysis. We performed MPS at rest and after separate dipyridamole or dobutamine stress in 121 chronic hemodialysis patients. More numerous, larger, and more intense reversible lesions were induced with dobutamine than with dipyridamole, mainly in the anteroseptal segments. Reversibility with dipyridamole but not dobutamine MPS was independently and strongly related with mortality associated with CAD and with fatal and non-fatal CAD. We hypothesize that the chronotropic action of dobutamine induced alterations of wall motion, leading to spurious perfusion defects, not unlike artifacts seen with left bundle branch block. Our study shows that even though dobutamine induced more pronounced myocardial ischemia than dipyridamole in chronic hemodialysis patients, dipyridamole MPS more accurately identifies patients at high risk for subsequent cardiac death or non-fatal CAD than dobutamine.
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| http://dx.doi.org/10.1038/ki.2009.160 | DOI Listing |
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