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Prognostic impact of SPECT-MPI after renal transplantation
Wael Abuzeid1,2, Robert M Iwanochko1,2,3, Xuesong Wang4
1Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
Insights
Single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) effectively predicts cardiovascular events in renal transplant recipients. This cardiac screening tool identifies patients at higher risk for death or hospitalization post-transplant.
Area of Science:
- Cardiology
- Nephrology
- Nuclear Medicine
Background:
- Renal transplantation is a common treatment for end-stage renal disease.
- Limited data exists on cardiac screening and prognosis after renal transplantation.
- The prognostic value of SPECT-MPI in this population is not well-established.
Purpose of the Study:
- To determine the prognostic value of SPECT-MPI in renal transplant recipients.
- To assess the association between SPECT-MPI findings and cardiovascular outcomes.
- To identify cardiac screening strategies for post-transplant patients.
Main Methods:
- A cohort of 4933 renal transplant recipients was identified from the Canadian Organ Replacement Register.
- Outcomes of 282 recipients with available SPECT-MPI results were analyzed.
- Morbidity and mortality data were obtained from hospitalization and vital statistics registries.
Main Results:
- 41% of patients had an abnormal summed stress score (SSS > 0) and 31% had an abnormal summed difference score (SDS > 0).
- An SSS ≥ 4 significantly increased the risk of cardiovascular death or hospitalization (aHR 2.52-2.61).
- An SDS ≥ 4 also significantly predicted cardiovascular death or hospitalization (aHR 2.96-3.26).
Conclusions:
- SPECT-MPI is a valuable tool for predicting cardiovascular risk in renal transplant recipients.
- Abnormal SPECT-MPI findings (SSS and SDS) are associated with increased cardiovascular events.
- Cardiac screening with SPECT-MPI can aid in prognostication and management post-transplant.
Background:
While renal transplantation is increasingly performed for end-stage renal disease, there is a paucity of data on cardiac screening and prognostication post-transplant. We determined the prognostic value of SPECT-MPI in a cohort who underwent renal transplantation.
Methods:
Among 4933 renal transplant recipients identified from the Canadian Organ Replacement Register, we examined outcomes of patients who underwent SPECT-MPI in Ontario, Canada. We determined morbidity and mortality using hospitalization and vital statistics registries, according to SPECT-MPI findings.
Results:
We studied 282 renal transplant recipients (median age 46 years [25th, 75th percentile 37, 58]) with detailed SPECT-MPI results available, followed for a median of 5.7 (3.3, 7.7) years. Among those undergoing SPECT-MPI (66% pharmacologic stress), 41% had an abnormal summed stress score (SSS > 0) and 31% demonstrated abnormal summed difference score (SDS > 0). Rates of cardiovascular death were 0.4 per 100 person-years among those with normal stress perfusion (SSS = 0) and 0.4 per 100 person-years with SDS = 0. After adjusting for age, sex, prior myocardial infarction (MI), and cardiac risk factors, an SSS ≥ 4 conferred increased risk of cardiovascular death or cardiovascular hospitalization with adjusted hazard ratios of 2.52 (95% CI 1.41, 4.52, P = .002) for SSS 4-6 and 2.61 (95% CI 1.52, 4.49, P < .001) for SSS ≥ 7. SDS was a significant predictor of cardiovascular death or hospitalization, with adjusted hazard ratios of 2.96 (95% CI 1.72, 5.09, P < .001) for SDS 4-6 and 3.26 (95% CI 1.64, 6.50, P < .001) for SDS ≥ 7.
Conclusion:
Among renal transplant recipients, SPECT-MPI predicted risk of cardiovascular death and cardiovascular hospitalization events.
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