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European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

07.06.2018 | Original Article

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

verfasst von: Christopher W. Ives, Wael A. AlJaroudi, Vineeta Kumar, Ayman Farag, Dana V. Rizk, Suzanne Oparil, Ami E. Iskandrian, Fadi G. Hage

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 11/2018

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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.

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Titel: Prognostic value of myocardial perfusion imaging performed pre-renal transplantation: post-transplantation follow-up and outcomes
verfasst von: Christopher W. Ives
Wael A. AlJaroudi
Vineeta Kumar
Ayman Farag
Dana V. Rizk
Suzanne Oparil
Ami E. Iskandrian
Fadi G. Hage
Publikationsdatum: 07.06.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 11/2018
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-018-4068-2

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

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

Abstract

Purpose

Methods

Results

Conclusions

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

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