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THE PROGNOSTIC VALUE OF SERIAL STRESS MYOCARDIAL PERFUSION IMAGING IN ASYMPTOMATIC END-STAGE RENAL DISEASE PATIENTS AWAITING KIDNEY TRANSPLANTATION
1482 JACC March 21, 2017 Volume 69, Issue 11
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) THE PROGNOSTIC VALUE OF SERIAL STRESS MYOCARDIAL PERFUSION IMAGING IN ASYMPTOMATIC END-STAGE RENAL DISEASE PATIENTS AWAITING KIDNEY TRANSPLANTATION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Nuclear Cardiology: Prognosis Abstract Category: 30. Non Invasive Imaging: Nuclear Presentation Number: 1159-207 Authors: Chiedozie Anokwute, Ibtihaj Fughhi, Marwan Wassouf, Michael Kharouta, Tania Campagnoli, Aviral Vij, George Khoudary, Rozi Khan, Meron Teshome, Andrew Appis, Rami Doukky, Rush University Medical Center, Chicago, IL, USA
Background: The role of serial SPECT myocardial perfusion imaging (MPI) for CAD surveillance in asymptomatic ESRD patients awaiting kidney transplantation (KT) is controversial. Methods: In a prospective cohort study, we analyzed consecutive asymptomatic KT candidates who had 2 MPI studies within 5 years prior to KT or end of follow up. Worsening MPI was defined as an increase in quantitatively measured total perfusion deficit (ΔTPD) > 5%. High clinical risk was defined as ≥3 KT risk factors set forth by AHA/ACCF statement (age > 60 y, HTN, DM, dyslipidemia, smoking, cardiovascular disease, dialysis > 1 y, LVH). The outcome was a composite of death or MI (D/MI).
Results: Among 656 KT candidates with serial MPI (mean interval 19 ± 11 months); 44% had normal initial MPI and 11% had ΔTPD > 5% on repeat MPI. Incidence of ΔTPD > 5% increased with increasing time gap between serial MPIs (Fig 1). There were 221 (34%) events of D/MI. ΔTPD > 5% was associated with increased risk of D/MI (Fig 2), even after adjusting for TPD on the initial MPI and the sum of risk factors (HR, 1.70; CI, 1.16-2.49; P = 0.007). ΔTPD > 5% was associated with increased risk of D/MI in patients with initial normal or abnormal MPI (Fig 3). ΔTPD > 5% was associated with increased risk of D/MI in patients with ≥3 risk factors, but not among those with ≤2 risk factors (Fig 4). Conclusions: These data support serial MPI testing in high risk KT candidates (≥3 risk factors), irrespective of initial MPI findings. Role of coronary revascularization in this context is unknown.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) THE PROGNOSTIC VALUE OF SERIAL STRESS MYOCARDIAL PERFUSION IMAGING IN ASYMPTOMATIC END-STAGE RENAL DISEASE PATIENTS AWAITING KIDNEY TRANSPLANTATION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Nuclear Cardiology: Prognosis Abstract Category: 30. Non Invasive Imaging: Nuclear Presentation Number: 1159-207 Authors: Chiedozie Anokwute, Ibtihaj Fughhi, Marwan Wassouf, Michael Kharouta, Tania Campagnoli, Aviral Vij, George Khoudary, Rozi Khan, Meron Teshome, Andrew Appis, Rami Doukky, Rush University Medical Center, Chicago, IL, USA
Background: The role of serial SPECT myocardial perfusion imaging (MPI) for CAD surveillance in asymptomatic ESRD patients awaiting kidney transplantation (KT) is controversial. Methods: In a prospective cohort study, we analyzed consecutive asymptomatic KT candidates who had 2 MPI studies within 5 years prior to KT or end of follow up. Worsening MPI was defined as an increase in quantitatively measured total perfusion deficit (ΔTPD) > 5%. High clinical risk was defined as ≥3 KT risk factors set forth by AHA/ACCF statement (age > 60 y, HTN, DM, dyslipidemia, smoking, cardiovascular disease, dialysis > 1 y, LVH). The outcome was a composite of death or MI (D/MI).
Results: Among 656 KT candidates with serial MPI (mean interval 19 ± 11 months); 44% had normal initial MPI and 11% had ΔTPD > 5% on repeat MPI. Incidence of ΔTPD > 5% increased with increasing time gap between serial MPIs (Fig 1). There were 221 (34%) events of D/MI. ΔTPD > 5% was associated with increased risk of D/MI (Fig 2), even after adjusting for TPD on the initial MPI and the sum of risk factors (HR, 1.70; CI, 1.16-2.49; P = 0.007). ΔTPD > 5% was associated with increased risk of D/MI in patients with initial normal or abnormal MPI (Fig 3). ΔTPD > 5% was associated with increased risk of D/MI in patients with ≥3 risk factors, but not among those with ≤2 risk factors (Fig 4). Conclusions: These data support serial MPI testing in high risk KT candidates (≥3 risk factors), irrespective of initial MPI findings. Role of coronary revascularization in this context is unknown.