Assessment of Coronary Artery Disease by Thallium Scan in Type-1 Diabetic Uremic Patients Awaiting Combined Pancreas and Renal Transplantation

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Abstract
Twenty-five type-1 diabetic uremic patients (14 men, 11 women, mean age forty ± eleven years, range, nineteen to sixty) were prospectively analyzed for coronary artery disease (CAD) by thallium scan (TLS) before syn chronus pancreas and kidney trans plantation. Duration of diabetes ranged from ten to thirty-two years (mean twenty-two ± five). Fifteen pa tients (60%) were in dialysis from two to sixty months (mean twenty ± eigh teen). Advanced diabetic degenerative complications were present in all pa tients. Twenty exercise and five phar macologic thallium scans were performed. Forty-four percent of patients (6 men, 5 women, mean age forty-two ± eleven years, range, twenty-six to sixty) had a positive (reversible or per manent defects) TLS. In 2/11 cases, se vere CAD required further cardiac investigations for therapeutic manage ment decision. A statistical correlation with resting ECG nonspecific ST-seg ment and T-wave abnormalities was observed (p<0.05) despite the absence of angor in 8 of the 11 patients. On the contrary, no statistical correlations were found regarding high blood pres sure, smoking, hypercholesterolemia, duration of diabetes, and duration of dialysis. In this particular diabetic popula tion (young age, male/female ratio = 1.2) with high incidence of silent isch emia, resting ECG repolarization ab normalities, though predictive, were not specific or prognostic of CAD severity; in these cases, exercise and pharmacologic TLS, a noninvasive and sensitive cardiovascular test, may be of great interest in diagnosis of CAD, allowing adequate cardiac man agement before, during, and after pancreas transplantation.