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Impact of change of ischemic burden on the outcomes of ESRD patients awaiting kidney transplantation

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

In asymptomatic patients with end-stage renal disease (ESRD) wait-listed for kidney transplantation (KT), it is unclear whether a change in ischemic burden on serial surveillance SPECT myocardial perfusion imaging (MPI) impacts outcome.

Methods and results

In a retrospective cohort of 700 asymptomatic KT candidates with ≥ 2 sequential SPECT-MPI studies, we defined a significant change in ischemic burden between MPIs as ΔSDS of ≥ 2 points. Patients were followed for mean 19 ± 12 months after MPI2 for cardiac death or myocardial infarction. Between MPIs, 29 (4%) subjects received coronary revascularization which was associated with a greater incidence of reduction in ischemic burden on MPI2 (31% vs. 17%, P = 0.049). Among 514 patients with no ischemia on MPI1 (SDS ≤ 1), 15% had new ischemia on MPI2 which was associated with increased MACE (adjusted HR 1.75; CI 1.02-3.01; P = 0.041). Among 186 patients with ischemia on MPI1 (SDS ≥ 2), 66% had improvement of ischemic burden on MPI2 which was associated with significantly lower MACE (adjusted HR 0.46; CI 0.25-0.82; P = 0.009). There was no significant interaction between coronary revascularization and improvement in ischemic burden impacting outcome (interaction P = 0.845).

Conclusion

Among KT candidates who underwent serial MPI for CAD surveillance, new ischemia was associated with increased MACE risk. Improvement in ischemic burden was associated with lower MACE risk irrespective of coronary revascularization status.

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Abbreviations

ACC:

American College of Cardiology

AHA:

American Heart Association

CAD:

Coronary artery disease

ESRD:

End-stage renal disease

MACE:

Major adverse cardiac events

MPI:

SPECT Myocardial perfusion imaging

PCI:

Percutaneous coronary intervention

TPD:

Total perfusion deficit

IPD:

Ischemic perfusion deficit

KT:

Kidney transplant

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Authors and Affiliations

  1. Division of Cardiology, Cook County Health, 1901 W. Harrison Street, Chicago, IL, 60612, USA

    Jonathan Tottleben MD, Andrea Torres MD & Rami Doukky MD, MSc, MBA, FASNC

  2. Division of Cardiology, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky MD, MSc, MBA, FASNC

Authors
  1. Jonathan Tottleben MD
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  2. Andrea Torres MD
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  3. Rami Doukky MD, MSc, MBA, FASNC
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Correspondence to Rami Doukky MD, MSc, MBA, FASNC.

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Funding

The study was funded, in part, by an investigator-initiated grant from Astellas Pharma Global Development (Northbrook, IL). The funding source had no input into the study design, execution, data analysis, data interpretation, or manuscript preparation and approval.

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Tottleben, J., Torres, A. & Doukky, R. Impact of change of ischemic burden on the outcomes of ESRD patients awaiting kidney transplantation. J. Nucl. Cardiol. 30, 1897–1903 (2023). https://doi.org/10.1007/s12350-023-03287-3

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  • DOI: https://doi.org/10.1007/s12350-023-03287-3

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