Article ; Online: The utility of myocardial perfusion imaging before renal transplantation: a retrospective analysis.
Nuclear medicine communications
2018 Volume 39, Issue 3, Page(s) 228–235
Abstract: Background: Renal transplantation (RT) reduces morbidity and mortality in patients with end-stage renal failure. Myocardial perfusion imaging provides prognostic information in patients with renal failure, but its role before transplantation remains ... ...
| Abstract | Background: Renal transplantation (RT) reduces morbidity and mortality in patients with end-stage renal failure. Myocardial perfusion imaging provides prognostic information in patients with renal failure, but its role before transplantation remains unclear. We performed a retrospective review assessing the prognostic value of technetium-99m sestamibi myocardial perfusion imaging at a tertiary UK centre. Patients and methods: We included scans performed between 2005 and 2012. Available scans were reanalysed to calculate the semiquantitative summed scores: sum rest score (SRS), sum stress score (SSS), sum difference score and sum motion score (SMS). Kaplan-Meier survival estimates assessed all-cause mortality and cardiac events according to scan findings, transplant decision and SSS. Cox-proportional hazards tested for an association between clinical/scan variables and all-cause mortality, and combined all-cause mortality/cardiovascular (CV) events. Results: One hundred and thirty-eight scans were identified with complete follow-up. During a median 40.4-month follow-up, 21 patients died, with 11 nonfatal CV events. There was no significant difference between groups according to scan findings for mortality (log-rank P=0.17) or mortality/CV events (P=0.06). An SSS greater than 8 was associated with higher mortality and CV events combined (P=0.028). An abnormal baseline ECG [hazard ratio (HR): 16.1] and higher SRS (HR: 2.3) were associated independently with higher mortality; an abnormal ECG (HR: 3.4) also predicted higher cardiac events/mortality. Conclusion: Moderate to severe perfusion defects by SSS were associated with higher mortality and CV events. Higher SRS was associated independently with increased mortality on multivariable analysis, highlighting a key role for semiquantitative analysis methods for risk stratification. An abnormal ECG was associated strongly with both endpoints, and may be a useful screening tool to select patients for further investigation. |
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| MeSH term(s) | Female ; Humans ; Kidney Transplantation ; Male ; Middle Aged ; Myocardial Perfusion Imaging ; Retrospective Studies ; Stress, Physiological |
| Language | English |
| Publishing date | 2018-03 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 758141-5 |
| ISSN | 1473-5628 ; 0143-3636 |
| ISSN (online) | 1473-5628 |
| ISSN | 0143-3636 |
| DOI | 10.1097/MNM.0000000000000793 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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