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J Nucl Cardiol. 2017 Feb;24(1):295-303. doi: 10.1007/s12350-016-0547-7. Epub 2016 Sep 23.

Prognostic impact of SPECT-MPI after renal transplantation.

Abuzeid W1,2, Iwanochko RM1,2,3, Wang X4, Kim SJ2,5, Husain M1,2,3,6, Lee DS7,8,9,10.

Author information

1
Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
2
University of Toronto, Toronto, ON, Canada.
3
Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
4
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
5
Division of Nephrology, University Health Network, Toronto, ON, Canada.
6
Ted Rogers Centre for Heart Research, Toronto, ON, Canada.
7
Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. dlee@ices.on.ca.
8
University of Toronto, Toronto, ON, Canada. dlee@ices.on.ca.
9
Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada. dlee@ices.on.ca.
10
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. dlee@ices.on.ca.

Abstract

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.

KEYWORDS:

MIBI; MPI; Renal transplant recipients; SPECT

PMID:
27663251
DOI:
10.1007/s12350-016-0547-7
[Indexed for MEDLINE]

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