EVALUATION OF DIABETIC-PATIENTS FOR RENAL AND PANCREAS TRANSPLANTATION - NONINVASIVE SCREENING FOR CORONARY-ARTERY DISEASE USING RADIONUCLIDE METHODS

Pharmacologic stress thallium scintigraphy is commonly performed in th e risk assessment of diabetic patients with nephropathy before kidney and/or pancreas transplantation; however, controversy exists regarding the test's accuracy in detecting coronary artery disease, Our purpose was to compare pharmacologic stress thallium scintigraphy and also ex ercise radionuclide ventriculography with coronary angiography in diab etic patients undergoing evaluation for transplantation, hi addition, we also determined the association of the test results with outcome af ter transplantation, The medical records of 47 patients (mean age, 37/-9 years) without clinical evidence of coronary artery disease were r eviewed, Forty-one patients had pharmacologic stress thallium scintigr aphy performed during their evaluation, Sensitivity was 62% and specif icity was 76% for detecting greater than or equal to 75% coronary arte ry stenosis (sensitivity was 53% and specificity was 73% for greater t han or equal to 50% stenosis), Thirty-five patients had exercise radio nuclide ventriculography performed, Sensitivity was 50% and specificit y was 67% for detecting greater than or equal to 75% coronary artery s tenosis (sensitivity was 44% slid specificity was 63% for greater than or equal to 50% stenosis), Thirty patients had both pharmacologic str ess thallium scintigraphy and exercise radionuclide ventriculography p erformed; when either test was abnormal, sensitivity in the detection of greater than or equal to 50% or greater than or equal to 75% stenos is tended to increase compared with pharmacologic stress thallium scin tigraphy alone (0.05<P<0.10), whereas specificity decreased (P<0.01). The incidence of adverse cardiac outcomes was identical for patients w ith abnormal thallium scintigrams and undergoing transplantation (2/11 ) compared with patients with normal scintigrams and undergoing transp lantation (4/22). We conclude that: (1) pharmacologic stress thallium scintigraphy and exercise radionuclide ventriculography are suboptimal screening tests for coronary artery disease in diabetic patients awai ting kidney and/or pancreas transplantation; (2) using the two radionu clide tests in combination results in a decrease in specificity; and ( 3) patients with abnormal thallium scintigrams can receive transplants with outcomes similar to those for patients with normal thallium scin tigrams.