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Validation of a clinical pathway to assess asymptomatic renal transplant candidates using myocardial perfusion imaging

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstracts

Background

An AHA/ACCF scientific statement proposed 8 risk factors to assess the need for noninvasive coronary artery disease (CAD) surveillance in asymptomatic patients undergoing evaluation for kidney transplantation. The clinical application of these risk factors and the role of noninvasive testing in this context have not been defined.

Methods and Results

We retrospectively followed a cohort of 581 consecutive kidney transplant recipients of whom 401 had pre-transplant radionuclide myocardial perfusion imaging (MPI) and 90 had pre-transplant coronary angiography. The sum of pre-transplant AHA/ACCF risk factors (age >60 years, hypertension, diabetes, cardiovascular disease, dyslipidemia, smoking, dialysis >1 year, left ventricular hypertrophy) was calculated. MPI scans were analyzed by a “blinded” reader. Patients were followed for a mean of 3.7 ± 2.3 years post-transplant for major adverse cardiac events (MACE), defined as cardiac death or non-fatal myocardial infarction. The sum of risk factors was associated with modest discriminatory capacity for obstructive angiographic CAD (area under the curve [AUC], 0.70; P = 0.004), 30-day post-operative MACE (AUC, 0.60; P = 0.036), and long-term MACE (AUC, 0.63; P < 0.001). A threshold of ≥3 risk factors was optimal for identifying patients at risk. MPI provided incremental predictive value for obstructive CAD (P = 0.02) and long-term MACE (P = 0.04) but not post-operative MACE (P = 0.56). MPI was best predictive of long-term MACE in intermediate risk (3-4 risk factors) patients.

Conclusions

Asymptomatic kidney transplant candidates with ≥3 AHA/ACCF risk factors are at increased cardiac risk, and should be considered for noninvasive CAD surveillance. Intermediate risk patients (3-4 factors) benefit the most from pre-transplant MPI to define long-term MACE risk.

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Abbreviations

ACCF:

American College of Cardiology Foundation

AHA:

American Heart Association

AUC:

Area under the curve

CAD:

Coronary artery disease

CI:

95% Confidence interval

CVD:

Cardiovascular disease

HR:

Hazard ratio

KDOQI:

Kidney disease outcomes quality initiative

MACE:

Major adverse cardiac events

MPI:

SPECT myocardial perfusion imaging

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Disclosure

Rami Doukky served on an advisory board and receives research funding from Astellas Pharma Global Development (Northbrook, IL). The other authors have no conflicts to report.

Author information

Authors and Affiliations

  1. Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA

    Rami Doukky MD, MSc, FASNC, Tania Campagnoli MD, MSc & Aviral Vij MD

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

    Rami Doukky MD, MSc, FASNC, Ibtihaj Fughhi MD, MSc, Michael Kharouta BS, MS, Chiedozie Anokwute MD & Andrew Appis MD

  3. Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA

    Rami Doukky MD, MSc, FASNC & Amjad Ali MD

  4. Department of Medicine, Fairview Hospital, Cleveland, OH, USA

    Marwan Wassouf MD

  5. Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Chicago, IL, 60612, USA

    Rami Doukky MD, MSc, FASNC

Authors
  1. Rami Doukky MD, MSc, FASNC
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  2. Ibtihaj Fughhi MD, MSc
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  3. Tania Campagnoli MD, MSc
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  4. Marwan Wassouf MD
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  5. Michael Kharouta BS, MS
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  6. Aviral Vij MD
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  7. Chiedozie Anokwute MD
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  8. Andrew Appis MD
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  9. Amjad Ali MD
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Corresponding author

Correspondence to Rami Doukky MD, MSc, FASNC.

Additional information

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

An audio interview was held April 13, 2017, between the Associate Editor, Fadi G. Hage, and Rami Doukky, co-author of this article. An audio file of the interview is available as an .mp3 download at the article webpage on SpringerLink.com, and can be found by searching for the article title or DOI.

Funding

The study was funded by an investigator-initiated grant from Astellas Pharma Global Development (Northbrook, IL). The grant fiduciary was Rush University Medical Center; the principal investigator is Rami Doukky. The funding source had no input into the study design, execution, data analysis, data interpretation, or manuscript preparation and approval.

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Doukky, R., Fughhi, I., Campagnoli, T. et al. Validation of a clinical pathway to assess asymptomatic renal transplant candidates using myocardial perfusion imaging. J. Nucl. Cardiol. 25, 2058–2068 (2018). https://doi.org/10.1007/s12350-017-0901-4

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  • DOI: https://doi.org/10.1007/s12350-017-0901-4

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