Abstract
In Japanese dialysis patients, the rate of death due to myocardial infarction is 4.6%.
It is controversial whether dialysis patients have an increased incidence of ischemic heart disease. Because it is usually considered that cineangiography is cont raindicated for dialysis patients, reports on coronary angiography in such cases have been rare. We studied 21 dialysis patients by cineangiograhy.
Through the analysis of coronary artery calcification in 41 dialysis patients using fluorocinescopy, nine (22%) revealed coronary calcifications. In this gronp, the duration of hemodialysis was longer than among patients who did not show such calcification. (p<0.02)
A series of 21 patients with histories of chest pain or dyspnea was examined invasively. Right and left cardiac catheterization, left ventriculography and coronary cineangiography were performed.
Eight patients had coronary stenosis (70% or more).
The freguency of coronary stenosis was not significantly differece between two groups with less than and more than one year's duration of diaysis, respectively calcificatic lesions accompanied by stenotic lesions were noted.
Our study suggests that long-term hemodialysis provokes coronary calcification, but this (calcification) has no relation to the coronary stenosis.
The patients with coronary stenosis did not differ statistically significantly from those without coronary stenosis in age, total cholesterol, HDL-cholesterol, CTR, Cardiac index or LVEDP.
The treaamill exercise test was performed according to a modification of the Bruce protocol. The sensitivity was 86% and specificity was 83%. Thus, in the patients on dialysis, this was useful.
Five out of six patients with a tendeney to pulmonary edema showed no coronary stenosis.
All patients in our series of 21 coronary cineangiographies subsequently underwent hemodialysis and no dangerous complication occurred. Recently, coronary revascularization can be performed successfully on dialysis patients. We believe that coronary angiography should bo undertaken in symptomatic dialyzed candidates.
