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Prognostic value of myocardial perfusion imaging performed pre-renal transplantation: post-transplantation follow-up and outcomes

  • Christopher W. Ives
  • Wael A. AlJaroudi
  • Vineeta Kumar
  • Ayman Farag
  • Dana V. Rizk
  • Suzanne Oparil
  • Ami E. Iskandrian
  • Fadi G. Hage
Original Article

Abstract

Purpose

Noninvasive stress testing is commonly performed as part of pre-renal transplantation (RT) evaluation. We evaluated the prognostic value of myocardial perfusion imaging (MPI)—myocardial perfusion, left ventricular ejection fraction (LVEF) and heart rate response (HRR)—post-RT.

Methods

Consecutive RT recipients were identified at our institution. MPI was considered abnormal when there was a perfusion defect or reduced ejection fraction. HRR to vasodilator stress was calculated as percentage change from baseline. The primary outcome was a composite of cardiovascular (CV) death, myocardial infarction (MI) and coronary revascularization (CR) post-RT; all-cause mortality was the secondary endpoint.

Results

Among 1189 RT recipients, 819 (69%) underwent MPI. Of those, 182 (22%) had abnormal MPI, and 31 (4%) underwent CR pre-RT. During a median follow-up of 56 months post-RT, the annual CV event and mortality rates for patients who had no MPI, normal MPI and abnormal MPI were 1.5%, 3.1% and 4.3% (p < 0.001), and 1.8%, 2.6% and 3.6% (p = 0.016), respectively. After multivariate adjustment, compared to patients without MPI, the hazard ratios (HRs) for CV events for normal and abnormal MPI were 1.47 ([0.93–2.33], p = 0.1) and 1.78 ([1.03–3.06], p = 0.04). Blunted HRR was an independent predictor of CV events (HR = 1.73 [1.04–2.86], p = 0.034) and all-cause death (HR = 2.26 [1.28–3.98], p = 0.005) after adjusting for abnormal MPI. Patients with abnormal MPI who underwent CR pre-RT had annual mortality rates similar to those with no or normal MPI (1.9% vs. 1.7–2.6%, p = 0.2), while those who did not undergo CR had higher annual mortality (4% vs. 1.7–2.6%, p = 0.003).

Conclusions

One in five RT recipients who underwent screening MPI had an abnormal study, an independent predictor of CV events. A blunted HRR to vasodilator stress was associated with increased risk of CV events and death, even after adjusting for abnormal MPI. Patients with abnormal MPI who underwent CR were at low risk of mortality following RT. MPI is a useful tool to aid in risk stratification pre-RT.

Keywords

Myocardial perfusion imaging Renal transplantation Kidney transplantation Outcomes Post-transplantation 

Abbreviations

ACC

American College of Cardiology

AHA

American Heart Association

CAD

Coronary artery disease

CI

Confidence interval

CR

Coronary revascularization

CV

Cardiovascular

ESRD

End-stage renal disease

HR

Hazard ratio

HRR

Heart rate response

LVEF

Left ventricular ejection fraction

MI

Myocardial infarction

MPI

Myocardial perfusion imaging

PDS

Perfusion defect size

RT

Renal transplantation

Notes

Compliance with ethical standards

Conflict of interest

Drs. Hage and Iskandrian have received research grants from Astellas Pharma USA. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Alabama School of MedicineBirminghamUSA
  2. 2.Division of Cardiovascular MedicineClemenceau Medical CenterBeirutLebanon
  3. 3.Division of Nephrology, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Division of Cardiovascular Disease, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.Section of CardiologyBirmingham Veterans Affairs Medical CenterBirminghamUSA

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