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Coronary Calcium Score May Replace Cardiovascular Risk Factors as Primary Risk Stratification Tool Before Kidney
Simon Winther1, Morten Bøttcher, Hanne S Jørgensen
11 Department of Cardiology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus, Denmark. 2 Department of Internal Medicine, Hospital Unit West, Herning, Denmark. 3 Department of Nephrology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus, Denmark. 4 Department of Nuclear Medicine and PET-Center, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus, Denmark. 5 University Clinic in Nephrology and Hypertension, Department of Medical Research and University of Aarhus, Holstebro Hospital, Holstebro, Denmark. 6 Department of Nephrology, Akershus University Hospital, University of Oslo, Oslo, Norway.
Insights
Coronary artery calcium score (CACS) is a superior tool for evaluating kidney transplant candidates for heart disease compared to traditional risk factors. CACS improves patient selection and guides diagnostic testing for obstructive coronary artery disease (CAD).
Area of Science:
- Cardiology
- Nephrology
- Radiology
Background:
- Cardiac evaluation is crucial before kidney transplantation, but optimal screening remains undefined.
- Current methods lack a definitive strategy for identifying candidates needing cardiac assessment.
- Investigating novel markers for efficient pre-transplant cardiac risk stratification is essential.
Purpose of the Study:
- To assess if coronary artery calcium score (CACS) can replace traditional cardiovascular risk factor assessment.
- To determine CACS's utility in selecting kidney transplant candidates for cardiac evaluation.
- To evaluate CACS's role in guiding the choice of noninvasive diagnostic modalities for obstructive coronary artery disease (CAD).
Main Methods:
- Prospective study of 167 kidney transplant candidates undergoing pre-transplant cardiac evaluation.
- Patients underwent risk factor assessment, CACS, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography.
- 138 patients completed all diagnostic tests for comprehensive analysis.
Main Results:
- Coronary artery calcium score (CACS) demonstrated higher accuracy (0.85) than risk factors (0.71) in identifying CAD.
- Adding CACS to risk factor assessment significantly improved correct patient reclassification (0.58).
- Coronary computed tomography angiography (CCTA) showed superior sensitivity and specificity for obstructive CAD compared to SPECT, especially in high CACS groups.
Conclusions:
- Coronary artery calcium score (CACS) effectively outperforms traditional risk factor assessment in predicting obstructive CAD in kidney transplant candidates.
- CACS serves as a better tool for selecting patients requiring cardiac evaluation.
- CACS aids in choosing the appropriate noninvasive diagnostic modality for coronary artery disease (CAD).
Background:
Cardiac evaluation before kidney transplantation is recommended, but no unequivocal screening strategy has yet been identified. We investigated if coronary artery calcium score (CACS) can replace cardiovascular risk factor assessment in selection of kidney transplantation candidates for cardiac evaluation and the choice of noninvasive modality for diagnosing obstructive coronary artery disease (CAD).
Methods:
We conducted a prospective study of 167 patients referred for pretransplantation cardiac evaluation. Patients underwent risk factor assessment, CACS, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography. In total, 138 patients completed all diagnostic tests.
Results:
In patients with CAD (22%), the number of risk factors and CACS score were higher than that in patients without CAD. The accuracy evaluated by the receiver-operating characteristic curve was higher for CACS than for risk factors, 0.85 versus 0.71 (P = 0.01). Adding CACS to the risk factor increased correct categorical net reclassification (0.58, P < 0.0001). Combining risk factors (≥3) with SPECT to identify patients with obstructive CAD resulted in less sensitivity (47% vs 80%) and higher specificity (94% vs 74%), compared with CCTA. In patients with low CACS (<400), SPECT had a lower sensitivity than CCTA (60% versus 80%) but the same specificity (80%). In patients with high CACS (≥400), SPECT had lower sensitivity than CCTA (50% vs 100%) and higher specificity (88% vs 8%).
Conclusions:
In kidney transplantation candidates, CACS outperformed risk factor assessment for predicting obstructive CAD and is a better tool for selecting patients and guiding the choice of noninvasive diagnostic modality in CAD.
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