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Cardiac Imaging Before Kidney Transplantation
Study Questions:
What is the predictive value of clinical risk factors and a variety of cardiac imaging modalities including coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and invasive coronary angiography (ICA) on major adverse cardiac events (MACE) and all-cause mortality in kidney transplantation candidates?
Methods:
The investigators prospectively evaluated 154 patients referred for kidney transplantation. All patients underwent CACS, coronary CTA, SPECT, and ICA testing. The clinical endpoints were extracted from patients’ interviews, patients’ records, and registries. Cox multiple regression analysis was performed including number of risk factors ≥3 and kidney transplants during follow-up as a time-dependent variable for each of the cardiac imaging modalities.
Results:
The mean follow-up time was 3.7 years. In total, 27 (17.5%) patients experienced MACE, and 31 (20.1%) patients died during follow-up. In a time-to-event analysis, both risk factors and CACS significantly predicted death, but only CACS predicted MACE. Combining risk factors with CACS identified a very-low-risk cohort with a MACE event rate of 2.1%, and a 1.0% mortality rate per year. Of the diagnostic modalities, coronary CTA and ICA significantly predicted MACE, but only coronary CTA predicted death. In contrast, SPECT predicted neither MACE nor death.
Conclusions:
The authors concluded that compared with traditional risk factors and other cardiac imaging modalities, CACS and coronary CTA seem superior for risk stratification in kidney transplant candidates.
Perspective:
This study reports that CACS is a better prognostic marker of MACE than traditionally used risk factors. Furthermore, combining risk factors and CACS in a prognostic model seems to improve risk prediction compared with using either risk factors or CACS alone. These data suggest that the use of a combination of risk factors and CACS and subsequent coronary CTA if indicated seems to be the most appropriate strategy for cardiac evaluation of renal transplant candidates. Additional large randomized studies are needed to compare diagnostic strategies and document the improved patient outcome by screening for coronary artery disease in asymptomatic kidney transplant candidates.
Keywords: Coronary Angiography, Coronary Artery Disease, Diagnostic Imaging, Kidney Transplantation, Myocardial Perfusion Imaging, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Tomography, Emission-Computed, Single-Photon, Tomography
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