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Effect of left ventricular mechanical dyssynchrony assessed pre-renal transplantation on cardiovascular death post transplantation

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

SPECT myocardial perfusion imaging (MPI) provides an assessment of LV mechanical dyssynchrony (LVMD) which correlates with CVD outcomes in diverse populations including those awaiting renal transplant (RT). The current study examines the association of LVMD on pre-transplant MPI with long-term CVD mortality post RT.

Methods

We identified consecutive patients who underwent RT at the University of Alabama at Birmingham between 2008 and 2012 from our prospectively collected database. 675 patients in the database underwent MPI and had images amenable for phase analysis. A blinded investigator retrieved the studies and derived LVMD indices including histogram bandwidth (BW), standard deviation (SD), phase peak, phase skewness, and phase kurtosis. The primary outcome was CVD death after RT.

Results

The study cohort had a median age of 54 years, 56% were men, 43% had diabetes, and 7% had prior myocardial infarction. Patients were on dialysis for a median of 3.4 years prior to RT and 34% received living donor transplants. During a median follow-up time after RT of 4.7 years (IQR 3.5 to 6.3 years) 59 patients (9%) succumbed to CVD death. Patients with wider BW, wider SD, lower skewness, and lower kurtosis had an increased risk of CVD death. On multivariate adjustment, BW and skewness remained as independent predictors of CVD deaths.

Conclusions

LVMD by phase analysis of gated SPECT MPI is associated with increased risk of CVD death after RT. This association is independent of demographics, comorbidities, and traditional findings on MPI and added incremental prognostic information. Assessment of LVMD should be considered for risk stratification in these patients.

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Abbreviations

BW:

Histogram bandwidth

CVD:

Cardiovascular disease

ESRD:

End-stage renal disease

LVEF:

Left ventricular ejection fraction

LVMD:

Left ventricular mechanical dyssynchrony

MPI:

Myocardial perfusion imaging

RT:

Renal transplant

SD:

Standard deviation

SPECT:

Single-photon emission computed tomography

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Author information

Authors and Affiliations

  1. Division of Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    William S. Morgan MD

  2. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Lyons Harrison Research Building 306, 1900 University BLVD, Birmingham, AL, 35294, USA

    Christopher W. Ives MD, Ayman A. Farag MD, Ami E. Iskandrian MD & Fadi G. Hage MD, FACC, FAHA, MASNC

  3. Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Vineeta Kumar MD

  4. Division of Molecular Imaging & Therapeutics, Department of Diagnostic Radiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Pradeep Bhambhvani MD

  5. Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Fadi G. Hage MD, FACC, FAHA, MASNC

Authors
  1. William S. Morgan MD
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  2. Christopher W. Ives MD
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  3. Ayman A. Farag MD
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  4. Vineeta Kumar MD
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  5. Pradeep Bhambhvani MD
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  6. Ami E. Iskandrian MD
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  7. Fadi G. Hage MD, FACC, FAHA, MASNC
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Correspondence to Fadi G. Hage MD, FACC, FAHA, MASNC.

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Morgan, W.S., Ives, C.W., Farag, A.A. et al. Effect of left ventricular mechanical dyssynchrony assessed pre-renal transplantation on cardiovascular death post transplantation. J. Nucl. Cardiol. 29, 2896–2905 (2022). https://doi.org/10.1007/s12350-021-02818-0

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