Impaired perfusion in the myocardial microcirculation in asymptomatic patients with Stages 1–4 chronic kidney disease with intrarenal arterial lesions

2020 ◽  
Author(s):  
Fei Xiao ◽  
Weiwei Zhang ◽  
Ya-Ni He ◽  
Jie Yang ◽  
Xinghong Liu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Single Photon ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Microvascular Disease ◽  
Emission Computed Tomography ◽  
Myocardial Microcirculation ◽  
Asymptomatic Patients ◽  
Arterial Lesions

Abstract Background Even mild renal disease is a powerful cardiovascular risk factor. However, the association between these pathophysiologic processes (especially in the early asymptomatic stage) is not known. Methods We recruited 243 asymptomatic patients with Stages 1–4 chronic kidney disease (CKD) without obstructive coronary artery disease (CAD). We distinguished different degrees of severity of intrarenal arterial lesions (IALs) according to the Oxford classification. Myocardial microcirculation perfusion was measured using single-photon emission computed tomography (SPECT). Summed scores of 17 stress and rest image segments produced the summed stress score (SSS) and summed rest score (SRS), respectively. The summed difference score (SDS) was calculated as the difference between the SSS and SRS. Coronary microvascular disease (CMD) was defined as abnormal SPECT (SSS ≥4 or SDS ≥2) in the absence of obstructive CAD. Results Participants showed a stepwise increase in CMD severity with IAL aggravation. SSS of no/mild/moderate/severe IALs was 1.64 ± 1.08, 2.56 ± 1.35, 4.42 ± 2.17 and 6.48 ± 3.52, respectively (P < 0.05 for all). SDS of no/mild/moderate/severe IALs was 1.29 ± 0.49, 1.75 ± 0.56, 3.06 ± 1.12 and 4.16 ± 1.85, respectively (P < 0.05 for all). The percentage of subclinical CMD in CKD patients with IALs was significantly higher than in those without IALs (69.57% versus 14.71%; P = 0.01). Multiple regression analysis showed that renal arteriolar hyalinization (odds ratio = 1.578, P = 0.009) was associated independently with subclinical CMD. Conclusions We demonstrated, for the first time, that impaired perfusion in the myocardial microcirculation in asymptomatic patients with Stages 1–4 CKD with IALs. Renal arteriolar hyalinization may be a useful marker of CMD in CKD.

scholarly journals P0702IMPAIRED MYOCARDIAL MICROCIRCULATION PERFUSION IN ASYMPTOMATIC STAGE 1-4 CHRONIC KIDNEY DISEASE PATIENTS WITH INTRARENAL ARTERIAL LESIONS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Huanzi Dai ◽  
Fei Xiao ◽  
Weiwei Zhang ◽  
Yani He
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Photon Emission ◽  
Microvascular Disease ◽  
Emission Computed Tomography ◽  
Myocardial Microcirculation ◽  
Asymptomatic Patients ◽  
Arterial Lesions ◽  
Asymptomatic Stage ◽  
Stage 1

Abstract Background and Aims Even mild renal disease is a powerful cardiovascular (CV) risk factor. However, the association between these pathophysiological processes, especially in the early asymptomatic stage, remains unclear. This study aimed to explore the relationship of cardio-renal microvascular disease in asymptomatic stage 1-4 chronic kidney disease (CKD) patients without obstructive coronary artery disease (CAD). Method This study consisted of 243 asymptomatic patients with stage 1-4 CKD who had no obstructive CAD. We distinguished different degrees of severity of intrarenal arterial lesions according to Oxford classification. Myocardial microcirculation perfusion was measured using single-photon emission computed tomography (SPECT). The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Coronary microvascular disease (CMD) was defined as abnormal SPECT MPI (SSS ≥4 or SDS≥2 on SPECT images) in the absence of obstructive CAD. Results The study subjects showed a stepwise increase in CMD severity with the aggravation of intrarenal arterial lesions; The SSS of no/mild/moderate/severe arterial lesions were 1.64±1.08, 2.56±1.35, 4.42±2.17, 6.48±3.52, respectively (all P<0.05); The SDS of no/mild/moderate/severe arterial lesions were 1.29±0.49, 1.75±0.56, 3.06±1.12, 4.16±1.85, respectively (all P<0.05). The percentage of subclinical CMD in CKD patients with intrarenal arterial lesions was significantly higher than those without arterial lesions (69.57% vs. 14.71%; P=0.01). Vice versa, the scores of intrarenal arterial lesions were significantly higher in patients who had myocardial perfusion defect (4.79±2.01 vs. 2.22±2.07, P=0.000), myocardial ischemia (3.69±2.16 vs. 2.35±1.69, P=0.001) compared to those without arterial lesions. Multiple regression analysis further supported renal arterioles hyalinization (OR=1.109, P=0.027) were independently associated with subclinical CMD in stage 1-4 CKD patients with no obstructive CAD. Conclusion This study demonstrated for the first time impaired myocardial microcirculation perfusion in asymptomatic stage 1-4 CKD patients with intrarenal arterial lesions. Renal arteriolar hyalinization may be a useful marker of the presence of CMD in CKD.

Most Important Prognostic Values to Predict Major Adverse Cardiovascular, Cerebrovascular, and Renal Events in Patients with Chronic Kidney Disease Including Hemodialysis for 2 Years

Cardiology ◽  
2019 ◽  
Vol 142 (1) ◽  
pp. 14-23
Author(s):  
Takuji Toyama ◽  
Shu Kasama ◽  
Makito Sato ◽  
Hirokazu Sano ◽  
Tetsuya Ueda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Myocardial Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
99Mtc Tetrofosmin ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Free Rate

Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular/cerebrovascular events. The aim of this study is to clarify whether stress myocardial perfusion single-photon emission computed tomography (SPECT) could predict cardiovascular/cerebrovascular events. In the Gunma-CKD SPECT Study, a multicenter prospective cohort trial, 311 patients with CKD (estimated glomerular filtration rate < 60 min/mL/1.73 m2) including 50 patients on hemodialysis underwent stress 99mTc-tetrofosmin SPECT for suspected ischemic heart disease and were followed for 2 years. The primary endpoint was the occurrence of cardiac death (CD), while the secondary endpoint was major adverse cardiovascular/cerebrovascular and renal events (MACCRE). MACCRE occurred in 91 out of 286 patients (CD in 13 and other MACCRE in 78 patients). According to a multivariate Cox analysis, hemoglobin (Hb) and end-systolic volume (ESV) were associated with CD (p < 0.05), while the summed difference score, diabetes mellitus (DM), and Hb were associated with MACCRE (p < 0.05). Kaplan-Meier analysis showed that the CD-free rate was higher in patients with ESV < 105 mL (log-rank, p = 0.0013), Hb > 12 g (log-rank, p = 0.0036), and a summed stress score < 6 (log-rank, p = 0.0058). The MACCRE-free rate was higher in patients with SDS = 0 (log-rank, p = 0.0097), without DM (log-rank, p = 0.0091), and with Hb > 12 g (log-rank, p = 0.0023). Myocardial perfusion SPECT parameters as well as renal anemia and DM can be reliable prognostic markers in patients with CKD including hemodialysis.

scholarly journals Relationships of Pelvic Vein Diameter and Reflux with Clinical Manifestations of Pelvic Venous Disorder

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 145
Author(s):  
Sergey Gavrilov ◽  
Anatoly Karalkin ◽  
Nadezhda Mishakina ◽  
Oksana Efremova ◽  
Anastasia Grishenkova
Keyword(s):  
Single Photon ◽  
Photon Emission ◽  
Clinical Manifestations ◽  
Emission Computed Tomography ◽  
Type I ◽  
Pelvic Vein ◽  
Asymptomatic Patients ◽  
Strong Positive Relationship ◽  
Vein Diameter

The causes of chronic pelvic pain (CPP) in patients with pelvic venous disorder (PeVD) are not completely understood. Various authors consider dilation of pelvic veins (PeVs) and pelvic venous reflux (PVR) as the main mechanisms underlying symptomatic forms of PeVD. The aim of this study was to assess relationships of pelvic vein dilation and PVR with clinical manifestations of PeVD. This non-randomized comparative cohort study included 80 female patients with PeVD who were allocated into two groups with symptomatic (n = 42) and asymptomatic (n = 38) forms of the disease. All patients underwent duplex scanning and single-photon emission computed tomography (SPECT) of PeVs with in vivo labeled red blood cells (RBCs). The PeV diameters, the presence, duration and pattern of PVR in the pelvic veins, as well as the coefficient of pelvic venous congestion (CPVC) were assessed. Two groups did not differ significantly in pelvic vein diameters (gonadal veins (GVs): 7.7 ± 1.3 vs. 8.5 ± 0.5 mm; parametrial veins (PVs): 9.8 ± 0.9 vs. 9.5 ± 0.9 mm; and uterine veins (UVs): 5.6 ± 0.2 vs. 5.5 ± 0.6 mm). Despite this, CPVC was significantly higher in symptomatic versus asymptomatic patients (1.9 ± 0.4 vs. 0.7 ± 0.2, respectively; p = 0.008). Symptomatic patients had type II or III PVR, while asymptomatic patients had type I PVR. The reflux duration was found to be significantly greater in symptomatic versus asymptomatic patients (median and interquartile range: 4.0 [3.0; 5.0] vs. 1.0 [0; 2.0] s for GVs, p = 0.008; 4.0 [3.0; 5.0] vs. 1.1 [1.0; 2.0] s for PVs, p = 0.007; and 2.0 [2.0; 3.0] vs. 1.0 [1.0; 2.0] s for UVs, p = 0.04). Linear correlation analysis revealed a strong positive relationship (Pearson’s r = 0.78; p = 0.007) of CPP with the PVR duration but not with vein diameter. The grade of PeV dilation may not be a determining factor in CPP development in patients with PeVD. The presence and duration of reflux in the pelvic veins were found to be predictors of the development of symptomatic PeVD.

scholarly journals Psychological factors of suspect coronary microvascular dysfunction in patients undergoing SPECT imaging

2020 ◽  
Author(s):  
Maria T. Bekendam ◽  
Ilse A. C. Vermeltfoort ◽  
Willem J. Kop ◽  
Jos W. Widdershoven ◽  
Paula M. C. Mommersteeg
Keyword(s):  
Psychological Factors ◽  
Single Photon ◽  
Reference Group ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Inducible Ischemia

Abstract Background Patients with myocardial ischemia in the absence of obstructive coronary artery disease (CAD) often experience anginal complaints and are at risk of cardiac events. Stress-related psychological factors and acute negative emotions might play a role in these patients with suspect coronary microvascular dysfunction (CMD). Methods and Results 295 Patients (66.9 ± 8.7 years, 46% women) undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT), were divided as follows: (1) a non-ischemic reference group (n = 136); (2) patients without inducible ischemia, but with a history of CAD (n = 62); (3) ischemia and documented CAD (n = 52); and (4) ischemia and suspect CMD (n = 45). These four groups were compared with regard to psychological factors and acute emotions. Results revealed no differences between the groups in psychological factors (all P > .646, all effect sizes d < .015). State sadness was higher for patients with suspect CMD (16%) versus the other groups (P = .029). The groups did not differ in the association of psychological factors or emotions with anginal complaints (all P values > .448). Conclusion Suspect CMD was not associated with more negative psychological factors compared to other groups. State sadness was significantly higher for patients with suspect CMD, whereas no differences in state anxiety and other psychological factors were found.

scholarly journals Radionuclide imaging methods in the diagnosis of microvascular dysfunction in non-obstructive coronary artery disease

2021 ◽  
Vol 26 (12) ◽  
pp. 4746
Author(s):  
A. N. Maltseva ◽  
A. V. Mochula ◽  
K. V. Kopyeva ◽  
E. V. Grakova ◽  
K. V. Zavadovsky
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Single Photon ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Small Diameter ◽  
Microvascular Dysfunction ◽  
Emission Computed Tomography ◽  
Flow Reserve ◽  
Artery Disease

Non-obstructive coronary artery disease is generally considered as a favorable type of pathology, however, a number of studies indicate that in non-obstructive atherosclerosis, the risk of such cardiovascular events as myocardial infarction, ischemic stroke, sudden cardiac death and decompensated heart failure cannot be completely ruled out. This may be due to microvascular dysfunction. However, due to the small diameter of vessels, none of the imaging techniques used in clinical practice makes it possible to assess microvascular morphology. To date, the most well-established methods for assessing myocardial perfusion are single-photon emission computed tomography (SPECT) and positron emission tomography (PET). The ability to quantify myocardial blood flow and coronary flow reserve allows SPECT and PET to be the methods of choice for non-invasive diagnosis of microvascular dysfunction. This review is devoted to current data on the clinical significance of radionuclide diagnosis of microvascular dysfunction in patients with non-obstructive coronary artery disease.

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