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Journal of Nuclear Cardiology

, Volume 25, Issue 6, pp 2058–2068 | Cite as

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

  • Rami Doukky
  • Ibtihaj Fughhi
  • Tania Campagnoli
  • Marwan Wassouf
  • Michael Kharouta
  • Aviral Vij
  • Chiedozie Anokwute
  • Andrew Appis
  • Amjad Ali
Original Article

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.

Keywords

Myocardial perfusion imaging renal transplant kidney transplant outcome perioperative 

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

Notes

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.

Supplementary material

12350_2017_901_MOESM1_ESM.pptx (973 kb)
Supplementary material 1 (PPTX 973 kb)
12350_2017_901_MOESM2_ESM.mp3 (8.4 mb)
Supplementary material 2 (MP3 8611 kb)

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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Rami Doukky
    • 1
    • 2
    • 3
    • 5
  • Ibtihaj Fughhi
    • 2
  • Tania Campagnoli
    • 1
  • Marwan Wassouf
    • 4
  • Michael Kharouta
    • 2
  • Aviral Vij
    • 1
  • Chiedozie Anokwute
    • 2
  • Andrew Appis
    • 2
  • Amjad Ali
    • 3
  1. 1.Division of CardiologyCook County Health and Hospitals SystemChicagoUSA
  2. 2.Division of CardiologyRush University Medical CenterChicagoUSA
  3. 3.Department of Radiology and Nuclear MedicineRush University Medical CenterChicagoUSA
  4. 4.Department of MedicineFairview HospitalClevelandUSA
  5. 5.Division of CardiologyJohn H. Stroger, Jr. Hospital of Cook CountyChicagoUSA

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