Myocardial microvascular dysfunction in the patients with end stage renal disease due to diabetic nephropathy evaluated by pharmacological stress 13N-ammonia PET Myocardial perfusion imaging

Objectives Several reports showed the myocardial microvascular dysfunction in the patients with the end-stage renal disease (ESRD). However, it is still unknown that the difference of the influence on the myocardial microcirculation between the etiologies of ESRD. We investigated the myocardial microcirculation using 13N-ammonia PET myocardial perfusion imaging (MPI) in the ESRD patient with maintained dialysis.

Methods Myocardial blood flow (MBF) at rest and during ATP induced hyperemia, and coronary flow reserve (CFR) in the ESRD patient were evaluated by 13N-ammonia PET MPI study. Twenty-seven diabetic ESRD patients and 50 non-diabetic ESRD patients without perfusion defect (SSS<3) were investigated. The patients with abnormal myocardial microcirculation is defined as follows; CFR<2.0: functional disorder of micro-vessels, stress MBF<2.0: reduced density of micro-capillaries, and both of them: mixed impairment.

Results No significant difference was observed between diabetic and non-diabetic ESED patients in rest MBF (0.98±0.25mL/g/min, 1.05±0.22mL/g/min, p=n.s.). Stress MBF was significantly reduced in diabetic ESRD patients than in non-diabetic ESRD patients (2.38±0.50mL/g/min, 2.98±0.75mL/g/min, p=0.0002). CFR was significantly reduced in diabetic ESRD patients than in non-diabetic ESRD patients (2.14±0.46, 2.74±0.58, p = 0.04). The severe microvascular dysfunction (MD) were more frequently observed in diabetic patients than in no-diabetic patients (CFR<2.0: 25.9%, 10.0%, respectively, p<0.05, Stress MBF<2.0: 22.2%, 8.0%, restrictively, p<0.01, both of them: 14.8%, 4.0%, restrictively, p<0.01). The logistic regression analysis revealed that the diabetic-ESRD most related to the severe MD.

Conclusions Reduced pharmacological-stress induced hyperemic MBF and reduced CFR were observed in the diabetic ESRD patients than in the non-diabetic ESRD patients evaluated by 13N-ammonia PET MPI study. It would reflect the myocardial microvascular dysfunction with poorer prognosis.