2001 年 34 巻 7 号 p. 1163-1167
There have been a few reports of a persistently abnormal “doughnut” pattern on technetium-99m-pyrophosphate (99mTc-PYP) myocardial scintigraphy in maintenance hemodialysis patients with severe ischemic heart disease. The present patient was a 65-year-old woman who had suffered from diabetes mellitus since the age of 46 years and had been on chronic hemodialysis because of diabetic nephropathy since the age of 62 years. She had no definite history of angina. Despite repeated episodes of congestive heart failure, she had been maintained on intensive hemodialysis and extracorporeal ultrafiltration method for two years. She complained of the sudden onset of chest pain on March 31, 1998. The electrocardiogram showed sinus tachycardia and there was 1-3mm of ST depression in leads V3-V6. Creatine phosphokinase (CPK) was 528IU/l and CRP was 4.1mg/dl. Echocardiography revealed anteroseptal hypokinesis. Myocardial scintigraphy using technetium-99m tetrofosmin (99mTc-tetrofosmin) showed defects in the anterior and posterolateral walls, and 99mTc-PYP showed a “doughnut” pattern of cardiac uptake. Coronary arteriography demonstrated 99% stenosis of seg. 1, 75% stenosis of seg. 7, 99% stenosis of seg. 9, and total obstruction of seg. 11 (AHA classification). Five months later, 99mTc-PYP myocardial scintigraphy showed persistence of the abnormal “doughnut” pattern of cardiac uptake. The endocardial biopsy specimen from the right ventricle revealed ischemic cardiomyopathy. Six months later, she died of congestive heart failure. 99mTc-PYP myocardial scintigraphy may be a practical and noninvasive means of diagnosing severe ischemic heart disease in patients with chronic renal failure secondary to diabetic nephropathy.
