Biomedical subjects

Hiroshi Fukuda

Publications and source records attributed to Hiroshi Fukuda.

At least 37 records · Page 2Linked to original sources

PubMed2005

Male elderly subthreshold depression patients have smaller volume of medial part of prefrontal cortex and precentral gyrus compared with age-matched normal subjects: a voxel-based morphometry.

BACKGROUND: The brain morphological changes in subthreshold depression (sD) have not been clarified. We examined the structural difference in regional gray matter volume between community-dwelling elderly subjects with sD and age-matched nondepressed normal subjects by voxel-based morphometry (VBM) based on magnetic resonance imaging (MRI). METHODS: Thirty-four community-dwelling elderly subjects with sD and 109 age-matched nondepressed normal subjects were studied by MRI. We defined subjects with sD as those who showed a Geriatric Depression Scale score of 15 or higher and a Mini Mental State Examination score of 22 or higher, and do not fulfill the criteria of major depressive disorder (MDD) in the Diagnostic and Statistical Manual for Mental Disorders IV. We collected brain magnetic resonance images of 34 subjects with sD and 109 age-matched normal subjects, and analyzed the difference in regional gray matter volume between these two groups by VBM. RESULTS: Male subjects with sD had significantly smaller volumes of the medial part of the bilateral frontal lobes and the right precentral gyrus than normal male subjects. LIMITATIONS: We have not clarified the discrepancy in the results of gender difference. CONCLUSIONS: Our study revealed that even community-dwelling elderly male subjects with sD show bilateral prefrontal gray matter volume reduction, which was reported to be observed in elderly patients with MDD, although there is no significant volume reduction in the hippocampus, which was also reported to be observed in MDD. Our study may contribute to clarifying the mechanism underlying brain pathological changes in sD.

Age of Onset↗

PubMed2005

Synthesis and in vivo biodistribution of BPA-Gd-DTPA complex as a potential MRI contrast carrier for neutron capture therapy.

p-boronophenylalanine (BPA) conjugated Gd-DTPA complex (3) was synthesized from the active methyne compound 6, the allylic carbonate 7, and BPA by the palladium-catalyzed allylation reaction followed by the DCC coupling reaction. The in vivo biodistribution of complex 3 was evaluated by prompt gamma-ray analysis and alpha-autoradiography using the tumor-bearing rats. High accumulation of gadolinium was observed in the kidney and the %ID values were 0.17 and 0.088 at 20 and 60 min after injection of 3, respectively. The accumulation was also observed in the tumor and the %ID values were 0.010 and 0.0025 at 20 and 60 min after injection, respectively. The visualization experiment of boron distribution in the tumor-bearing rat by alpha-autoradiography indicates that boron was accumulated in the tumor and the intestines at 20 min after injection.

Animals↗

PubMed2005

Cortical mechanisms of visual self-recognition.

Several lines of evidence have suggested that visual self-recognition is supported by a special brain mechanism; however, its functional anatomy is of great controversy. We performed an event-related functional magnetic resonance imaging (fMRI) study to identify brain regions selectively involved in recognition of one's own face. We presented pictures of each subject's own face (SELF) and a prelearned face of an unfamiliar person (CONT), as well as two personally familiar faces with high and low familiarity (HIGH and LOW, respectively) to test selectivity of activation to the SELF face. Compared with the CONT face, activation selective to the SELF face was observed in the right occipito-temporo-parietal junction and frontal operculum, as well as in the left fusiform gyrus. On the contrary, the temporoparietal junction in both the hemispheres and the left anterior temporal cortex, which were activated during recognition of HIGH and/or LOW faces, were not activated during recognition of the SELF face. The results confirmed the partial distinction of the brain mechanism involved in recognition of personally familiar faces and that in recognition of one's own face. The right occipito-temporo-parietal junction and frontal operculum appear to compose a network processing motion-action contingency, a role of which in visual self-recognition has been suggested in previous behavioral studies. Activation of the left fusiform gyrus selective to one's own face was consistent with the results of two previous functional imaging studies and a neuropsychological report, possibly suggesting its relationship with lexical processing.

Adolescent↗

PubMed2005

Effects of tissue heterogeneity on cerebral vascular response to acetazolamide stress measured by an I-123-IMP autoradiographic method with single-photon emission computed tomography.

OBJECTIVES: Single-photon emission computed tomography (SPECT) with iodine-123 (123I)-labeled N-isopropyl-p-iodoamphetamine (IMP) is widely used in measuring the cerebral blood flow (CBF) response to acetazolamide stress for assessment of cerebral vascular reserve. To quantitate CBF by means of SPECT with IMP, an autoradiographic (ARG) method has been developed and is widely used. Because the relation between the brain counts on the SPECT scan and CBF is not linear in the ARG method, a mixture of gray and white matter in a pixel causes errors in the calculation of CBF. In the present study, errors in the calculation of CBF and vascular response to acetazolamide stress by the ARG method due to tissue heterogeneity were estimated by simulation study. Correction for effects of tissue heterogeneity in SPECT data was also attempted. METHODS: Images of gray and white matter fraction were obtained by voxel-based morphometry analysis of magnetic resonance (MR) imaging data set. Ideal CBF images, which were generated from gray and white matter fraction images with assumed blood flow values for gray and white matter, were compared to CBF images generated by the ARG method. Correction for effects of tissue heterogeneity in SPECT data was performed with gray and white matter fraction data obtained from MR images. RESULTS: Systematic underestimation of CBF due to tissue heterogeneity was observed in all brain regions. In the neocortical regions, underestimation by -21% to -16%, -26% to -20%, -31% to -24%, and -35% to -27% was observed for gray and white matter blood flow of 80 and 20, 100 and 25, 120 and 30, and 140 and 35 ml/100 ml/min, respectively. Vascular response was also systematically underestimated in most brain regions. Vascular responses in the neocortical regions ranged from 17% to 20%, from 31% to 37%, and from 42% to 52% when ideal vascular responses were 25%, 50%, and 75%, respectively. After correction for the effects of tissue heterogeneity, values of vascular response to acetazolamide stress ranged from 64% to 116% in the neocortical regions, whereas values obtained by the ARG method ranged from 48% to 52%. CONCLUSION: Underestimation of the vascular response to acetazolamide stress due to tissue heterogeneity should be considered in the estimation of cerebral vascular reserve.

Acetazolamide↗

PubMed2005

Apparent CBF decrease with normal aging due to partial volume effects: MR-based partial volume correction on CBF SPECT.

Several studies using single photon emission tomography (SPECT) have shown changes in cerebral blood flow (CBF) with age, which were associated with partial volume effects by some authors. Some studies have also demonstrated gender-related differences in CBF. The present study aimed to examine age and gender effects on CBF SPECT images obtained using the 99mTc-ethyl cysteinate dimer and a SPECT scanner, before and after partial volume correction (PVC) using magnetic resonance (MR) imaging. Forty-four healthy subjects (29 males and 15 females; age range, 27-64 y; mean age, 50.0 +/- 9.8 y) participated. Each MR image was segmented to yield grey and white matter images and coregistered to a corresponding SPECT image, followed by convolution to approximate the SPECT spatial resolution. PVC-SPECT images were produced using the convoluted grey matter MR (GM-MR) and white matter MR images. The age and gender effects were assessed using SPM99. Decreases with age were detected in the anterolateral prefrontal cortex and in areas along the lateral sulcus and the lateral ventricle, bilaterally, in the GM-MR images and the SPECT images. In the PVC-SPECT images, decreases in CBF in the lateral prefrontal cortex lost their statistical significance. Decreases in CBF with age found along the lateral sulcus and the lateral ventricle, on the other hand, remained statistically significant, but observation of the spatially normalized MR images suggests that these findings are associated with the dilatation of the lateral sulcus and lateral ventricle, which was not completely compensated for by the spatial normalization procedure. Our present study demonstrated that age effects on CBF in healthy subjects could reflect morphological differences with age in grey matter.

Adult↗

PubMed2005

An experimental study on O-[18F]fluoromethyl-L-tyrosine for differentiation between tumor and inflammatory tissues.

OBJECTIVE: O-[18F]fluoromethyl-L-tyrosine (18F-FMT) is a recently developed tumor-detecting agent with simple preparation and high radiochemical yields. The aim of this study was to assess the potency of 18F-FMT for differentiating tumor and inflammatory tissues using an animal model with an implanted tumor and experimentally induced inflammatory foci. METHODS: An ascites hepatoma cell line, AH109A, turpentine oil and Staphylococcus aureus were inoculated subcutaneously into Donryu rats as a tumor model, aseptic inflammation model and bacterial infection model, respectively. The biodistribution of radioactivity was assessed in rats at 5, 10, 30, 60, and 120 min after injection with 18F-FMT. Dual tracer whole-body and macro autoradiographies were performed 60 min after injection with a mixture of 18F-FMT and 2-deoxy-D-[1-14C]glucose (14C-DG). RESULTS: Tumor uptake of 18F-FMT was on average 1.27% injected dose per gram of tissue (%ID/g) and 1.43% ID/g at 30 min and 60 min, respectively and significantly higher than that in other normal tissues, except the pancreas (3.48% ID/g at 60 min). The uptakes in the aseptic and bacterial inflammatory tissues were very low and were not different from those of the background tissues. Dual tracer whole-body and macro autoradiographic studies showed that tumor uptake of 18F-FMT was clearly higher than uptake by the other tissues, while 18F-FMT accumulated much less both in aseptic and bacterial inflammatory tissues. In contrast, the 14C-DG images showed high accumulations not only in tumors but also in aseptic and bacterial inflammatory tissues. CONCLUSION: 18F-FMT seems to be a promissing tracer for the differentiation between tumor and inflammation because of higher specificity to tumor.

Animals↗

PubMed2005

Human cerebral circulation: positron emission tomography studies.

We reviewed the literature on human cerebral circulation and oxygen metabolism, as measured by positron emission tomography (PET), with respect to normal values and of regulation of cerebral circulation. A multicenter study in Japan showed that between-center variations in cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) values were not considerably larger than the corresponding within-center variations. Overall mean +/- SD values in cerebral cortical regions of normal human subjects were as follows: CBF = 44.4 +/- 6.5 ml/100 ml/min; CBV = 3.8 +/- 0.7 ml/100 ml; OEF = 0.44 +/- 0.06; CMRO2 = 3.3 +/- 0.5 ml/100 ml/min (11 PET centers, 70 subjects). Intrinsic regulation of cerebral circulation involves several factors. Autoregulation maintains CBF in response to changes in cerebral perfusion pressure; chemical factors such as PaCO2 affect cerebral vascular tone and alter CBF; changes in neural activity cause changes in cerebral energy metabolism and CBF; neurogenic control of CBF occurs by sympathetic innervation. Regional differences in vascular response to changes in PaCO2 have been reported, indicating regional differences in cerebral vascular tone. Relations between CBF and CBV during changes in PaCO2 and during changes in neural activity were in good agreement with Poiseuille's law. The mechanisms of vascular response to neural activation and deactivation were independent on those of responses to PaCO2 changes. CBV in a brain region is the sum of three components: arterial, capillary and venous blood volumes. It has been reported that the arterial blood volume fraction is approximately 30% in humans and that changes in human CBV during changes in PaCO2 are caused by changes in arterial blood volume without changes in venous blood volume. These findings should be considered in future studies of the pathophysiology of cerebrovascular diseases.

Brain↗

PubMed2005

Multiplanar reformat and volume rendering of a multidetector CT scan for path planning a fluoroscopic procedure on Gasserian ganglion block-a preliminary report.

In the treatment of trigeminal neuralgia, Gasserian block under fluoroscopical guidance may be difficult because of anatomic variability, and difficulty in identification of the foramen ovale. We introduce how to use three-dimensional CT in the preprocedural planning. We determine the skull-rotation angle in which the foramen ovale is best visualized, the relationship (distance, angle) between the virtual puncture point and anatomical landmarks, and the distance between the virtual puncture point and the foramen.

Aged↗

PubMed2005

Changes in cerebral blood flow and cerebral oxygen metabolism during neural activation measured by positron emission tomography: comparison with blood oxygenation level-dependent contrast measured by functional magnetic resonance imaging.

The discrepancy between the increases in cerebral blood flow (CBF) and CMRO2 during neural activation causes an increase in venous blood oxygenation and, therefore, a decrease in paramagnetic deoxyhemoglobin concentration in venous blood. This can be detected by functional magnetic resonance imaging (fMRI) as blood oxygenation level-dependent (BOLD) contrast. In the present study, changes in the cerebral oxygen extraction fraction (OEF) that corresponds to the ratio of CMRO2 to CBF, and in the BOLD signal during neural activation, were measured by both positron emission tomography (PET) and fMRI in the same human subjects. C15O, 15O2, and H2(15)O PET studies were performed in each subject at rest (baseline) and during performance of a right-hand motor task. Functional magnetic resonance imaging studies were then performed to measure the BOLD signal under the two conditions. During performance of the motor task, a significant increase in CBF and a significant decrease in OEF were observed in the left precentral gyrus, left superior frontal gyrus, right precentral gyrus, right cingulate gyrus, and right cerebellum. A significant positive correlation was observed between changes in the CBF and the BOLD signal, and a significant negative correlation was observed between changes in the OEF and the BOLD signal. This supports the assumption on which BOLD contrast studies during neural activation are based.

Adult↗

PubMed2005

Changes in the arterial fraction of human cerebral blood volume during hypercapnia and hypocapnia measured by positron emission tomography.

Hypercapnia induces cerebral vasodilation and increases cerebral blood volume (CBV), and hypocapnia induces cerebral vasoconstriction and decreases CBV. Cerebral blood volume measured by positron emission tomography (PET) is the sum of three components, that is, arterial, capillary, and venous blood volumes. Changes in arterial blood volume (V(a)) and CBV during hypercapnia and hypocapnia were investigated in humans using PET with H(2)(15)O and (11)CO. Arterial blood volume was determined from H(2)(15)O PET data by means of a two-compartment model that takes V(a) into account. Baseline CBV and values during hypercapnia and hypocapnia in the cerebral cortex were 0.034+/-0.003, 0.038+/-0.003, and 0.031+/-0.003 mL/mL (mean+/-s.d.), respectively. Baseline V(a) and values during hypercapnia and hypocapnia were 0.015+/-0.003, 0.025+/-0.011, and 0.007+/-0.003 mL/mL, respectively. Cerebral blood volume changed significantly owing to changes in PaCO(2), and V(a) changed significantly in the direction of CBV changes. However, no significant change was observed in venous plus capillary blood volume (=CBV-V(a)). This indicates that changes in CBV during hypercapnia and hypocapnia are caused by changes in arterial blood volume without changes in venous and capillary blood volume.

Adult↗

PubMed2005

Piperazine propanol derivative as a novel antifungal targeting 1,3-beta-D-glucan synthase.

1,3-beta-D-Glucan synthase, which synthesizes a main component of fungal cell wall, is one of the promising targets for antifungal agents. In order to identify novel chemical classes of 1,3-beta-D-glucan synthase inhibitors, we screened a chemical library monitoring inhibition of the Candida albicans 1,3-beta-D-glucan synthase activity. The piperazine propanol derivative GSI578 [(2,6-difluoro-phenyl)-carbamic acid 3-(4-benzothiazol-2-yl-piperazine-1-yl)-propyl ester] was identified as a potent inhibitor against 1,3-beta-D-glucan synthase with an IC50 value of 0.16 microM. GSI578 exhibited in vitro antifungal activity against pathogenic fungi including C. albicans and Aspergillus fumigatus. Temperature-sensitive mutations of the FKS1 gene in the Deltafks2 background of Saccharomyces cerevisiae, where FKS1 and FKS2 encode putative catalytic subunits of 1,3-beta-D-glucan synthase, altered sensitivity to GSI578. This suggests that the antifungal activity of the piperazine propanol derivative has an effect on 1,3-beta-D-glucan synthase inhibition. Results of our initial evaluation suggest that the piperazine propanol derivative is a novel chemical structure of the class of antifungals which inhibit fungal cell growth by inhibiting fungal 1,3-beta-D-glucan synthase.

Antifungal Agents↗

PubMed2005

Prediction of cardiac events in patients with transient left ventricle dilation on stress myocardial perfusion SPECT images.

BACKGROUND: The purpose of this study was to investigate cardiac events in patients with transient left ventricle (LV) dilation on stress myocardial perfusion single-photon emission computed tomography images (MPI). METHODS AND RESULTS: Consecutive patients (n=53, 31 males, mean age 71 years) with transient LV dilation on thallium-201 stress MPI (treadmill: 21, pharmacologic: 32) were followed for 17 months. Follow-up time was censored at the occurrence of cardiac death, congestive heart failure, acute coronary syndrome, or revascularization. Images were scored and then the summed stress score (SSS), summed rest score, and summed difference score were calculated. Cardiac death occurred in 3 patients, hospitalization occurred in 8 patients, and revascularization occurred in 20 patients. The combined cardiac event rate was 59% (76% for exercise stress vs 47% for pharmacologic stress, p=0.034). Cox regression analysis demonstrated that a combination of higher SSS and slow washout rate was the best predictor of cardiac events (hazard ratio =3.3, p=0.029). CONCLUSIONS: A high cardiac event rate is associated with transient LV dilation on thallium-201 stress MPI. The event rate is particularly high for exercise stress MPI. Furthermore, a combination of the SSS and thallium-201 slow washout is the best predictor of cardiac events in patients with transient LV dilation.

Aged↗

PubMed2005

Need for documentation of guidelines for coronary artery spasm: an investigation by questionnaire in Japan.

BACKGROUND: Because there are no guidelines concerning coronary spasm in Japan, the present study examined the current status of the spasm provocation test. METHODS AND RESULTS: Questionnaires concerning the number of cases of coronary angiography, percutaneous coronary intervention, and invasive/non-invasive spasm provocation tests over 3 years (2001-2003) and the status of spasm provocation tests were sent to members of the Japanese Circulation Society in 120 cardiology hospitals in the Chugoku and Shikoku areas. Completed surveys were returned from 45 hospitals, giving a collection rate of 38%. As a spasm provocation agent, acetylcholine tests were performed in 29 hospitals, and ergonovine tests in 18 hospitals. Non-invasive spasm provocation tests were performed in only 9 hospitals (20%). In total, 5,267 patients underwent acetylcholine spasm provocation test (2,387 patients) or ergonovine spasm provocation test (2,880 patients) and vasospastic angina was diagnosed in 1,663 (2.4%) patients. Invasive spasm provocation tests were performed in 7.8% of patients with diagnostic catheterization and the spasm-positive rate was 31.6%. The difference among hospitals concerning the number of invasive spasm provocation tests was remarkable, and the angiographic spasm-positive standard and acetylcholine/ergonovine dose varied among the hospitals. CONCLUSIONS: Guidelines on coronary spasm in Japan are essential to overcome the current differences between institutions.

Angina Pectoris, Variant↗

PubMed2005

Variability of repeated coronary artery calcium measurements by 16-MDCT with retrospective reconstruction.

OBJECTIVE: High reproducibility on coronary calcium scoring is an important factor in monitoring the progression of coronary atherosclerosis. The purposes of this study were, using a 16-MDCT scanner with retrospective reconstruction, to compare the effects of thin-slice images and overlapping image reconstruction on the reproducibility of coronary calcium scoring and to compare 16-MDCT with electron beam CT (EBCT). MATERIALS AND METHODS: Fifty patients underwent two sequential examinations using both EBCT and MDCT. For MDCT, images were reconstructed from the same raw data using the following thicknesses and increments (thickness/increment): 1.25 mm/1.25 mm, 2.5 mm/2.5 mm, and 2.5 mm/1.25 mm. The Agatston, volume, and mass scores were calculated on four pairs of image sets. Statistical analysis was performed to determine significant differences in interscan variability among image acquisition protocols and among measurement algorithms. RESULTS: Overlapping reconstructed images (thickness/increment, 2.5 mm/1.25 mm) obtained on a 16-MDCT scanner showed the lowest variability (mean, 13%; median, 10%) when compared with the Agatston score. CONCLUSION: The use of 16-MDCT with overlapping reconstruction by retrospective reconstruction, yielding low variability of coronary artery calcium measurement on two sequential scans, has an advantage over EBCT in monitoring the progression of atherosclerosis.

Aged↗

PubMed2004

Validation of anatomical standardization of FDG PET images of normal brain: comparison of SPM and NEUROSTAT.

PURPOSE: Statistical parametric mapping (SPM) and NEUROSTAT (NS) are widely used for intersubject statistical analysis of brain images. We investigated individual anatomical variations after standardization of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) images of normal brain and compared the differences in the standardized images obtained from SPM and NS. METHODS: Twenty healthy normal subjects were recruited for FDG PET and magnetic resonance imaging (MRI) studies. Sylvian fissures (SF), cingulate sulci (CingS) and central sulci (CtlS) were marked on the brain surface of each individual's co-registered MR images. Then spatial standardization was performed on each subject's PET images using SPM99 and NS with NS's FDG template image, and each subject's MR images (with the SF, CingS, and CtlS marked in advance) were standardized using the sets of parameters obtained from PET standardization by SPM and NS, respectively. The coordinates of each subject's SF, CingS, and CtlS detected on the MR images standardized by the two methods were measured and compared with those on the template images. RESULTS: The mean individual deviations from the averaged coordinates for the markers on the SF, CingS and CtlS standardized by SPM and by NS were no more than 0.21-1.15 mm. The number of voxels within the brain volume on standardized MR images of all 20 subjects was 88.0% of the total number of brain volume voxels for SPM and 85.3% for NS. CONCLUSION: This study demonstrates that SPM and NS yield relatively small differences in standardization and that both methods are effective and valid for PET studies in normal subjects.

Adolescent↗

PubMed2004

Expression of AIE-75 PDZ-domain protein induces G2/M cell cycle arrest in human colorectal adenocarcinoma SW480 cells.

AIE-75 has been known as a 75-kDa autoantigen detected in the serum of autoimmune enteropathy (AIE) and as a colon cancer-related antigen, and now designated as a gene causative of Usher syndrome type 1C hereditary syndromic hearing loss. It binds to a novel putative tumor suppressor MCC2 that is homologous to MCC (mutated in colon cancer) through a PSD-95/Dlg/ZO-1 (PDZ) domain. To clarify the functional role in colon cancer cells, we transfected AIE-75 gene into SW480 colon cancer cells which do not express AIE-75. Expression of AIE-75 suppressed growth of SW480 cells in vitro in correlation with the expression levels. It was due mainly to G2/M phase cell cycle arrest associated with mitotic slippage, resulting in emergence of hyperploid giant-nucleated or multi-nucleated cells. Screening of proteins that bound to PDZ domains of AIE-75 by a yeast two hybrid system showed that three serine/threonine phosphatase catalytic subunits (PP2AC-alpha, PP2AC-beta, and PPP6C) could bind to AIE-75. Since PP2AC is known to regulate G2/M checkpoint, we suggest that AIE-75 interacts with PP2AC and prevent cells to transit mitotic phase.

Adaptor Proteins, Signal Transducing↗

PubMed2004

Role of the cerebellum in implicit motor skill learning: a PET study.

To depict neural substrates of implicit motor learning, regional cerebral blood flow was measured using positron emission tomography (PET) in 13 volunteers in the rest condition and during performance of a unimanual two-ball rotation task. Subjects rotated two balls in a single hand; a slow rotation (0.5 Hz) was followed by two sessions requiring as rapid rotation as possible. The process was repeated four times by a single hand (Block 1) and then by the opposite hand (Block 2). One group of volunteers began with the right hand (n = 7), and the other with the left (n = 6). Performance was assessed by both quickness and efficiency of movements. The former was assessed with the maximum number of rotation per unit time, and the latter with the electromyographic activity under constant speed of the movement. Both showed learning transfer from the right hand to the left hand. Activation of cerebrum and cerebellum varied according to hand. Activation common to both hands occurred in the bilateral dorsal premotor cortex and parasagittal cerebellum, right inferior frontal gyms, left lateral cerebellum and thalamus, supplementary motor area, and cerebellar vermis. The left lateral cerebellum showed the most prominent activation on the first trial of the novel task, and hence may be related the early phase of learning, or "what to do" learning. Left parasagittal cerebellum activity diminished with training both in first and second blocks, correlating inversely with task performance. This region may therefore be involved in later learning or "how to do" learning. The activity of these regions was less prominent with prior training than without it. Thus the left cerebellar hemisphere may be related to learning transfer across hands.

Adult↗

PubMed2004

Prognostic value of stress myocardial perfusion imaging using adenosine triphosphate at the beginning of haemodialysis treatment in patients with end-stage renal disease.

BACKGROUND: Non-invasive detection of coronary artery disease (CAD) remains difficult in patients with end-stage renal disease (ESRD). This study evaluated the ability of pharmacologic stress myocardial perfusion imaging to predict cardiac events in patients with ESRD. METHODS: A prospective study was carried out in 49 consecutive patients with ESRD. Thallium-201 single photon emission computed tomography (SPECT) using high-dose adenosine triphosphate (ATP) was performed within 1 month of the beginning of haemodialysis. The study end-point was a cardiac event or the 1-year anniversary of the SPECT study. RESULTS: Twenty-four patients (17 diabetics, 57% and seven non-diabetics, 37%) had myocardial perfusion defects. The remaining 25 patients had normal perfusion images. Fifteen patients had non-fatal cardiac events and two patients died of a cardiac cause. All patients who had non-fatal cardiac events underwent myocardial revascularization and survived until the end of follow-up. The 1-year cardiac event-free survival rate was 34% among patients with perfusion defects and 96% among patients without perfusion defects (P<0.001). The presence of a myocardial perfusion defect was the only independent predictor of 1-year cardiac events both in overall (HR, 49.91; 95% CI, 5.15-484.00; P<0.001) and in diabetic patients (HR, 33.72; 95% CI, 2.96-383.5; P = 0.005). Diabetes and an increased C-reactive protein were associated with the progression of CAD. CONCLUSIONS: Normal myocardial perfusion imaging by stress thallium-201 SPECT using high-dose ATP performed within 1 month after the beginning of haemodialysis treatment is a powerful predictor of cardiac event-free survival in patients with ESRD.

Cardiovascular Diseases↗