Diagnostic Performance of Coronary CT Angiography and Myocardial Perfusion Imaging in Kidney Transplantation Candidates

Winther, Simon; Svensson, My; Jørgensen, Hanne Skou; Bouchelouche, Kirsten; Gormsen, Lars Christian; Pedersen, Bjørn Panyella; Holm, Niels Ramsing; Bøtker, Hans Erik; Ivarsen, Per; Bøttcher, Morten

doi:10.1016/j.jcmg.2014.12.028

Cited by 89 publications

(69 citation statements)

References 19 publications

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“…Recently, plaque assessment by coronary computed tomography angiography (CTA) showed some promise in predicting CVD outcomes among patients with CKD. 23–25 In our study, inclusion of CAC score in the prediction models led to a significant increase in c-statistics and positive NRI and IDI over ACC/AHA atherosclerotic CVD risk factors and other novel risk factors. These findings suggest that CAC could be used for risk stratification and prediction among CKD patients.…”

Section: Discussionmentioning

confidence: 54%

Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease

et al. 2017

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Importance Coronary artery calcification (CAC) is highly prevalent in patients with pre-dialysis chronic kidney disease (CKD). However, there are sparse data on the association of CAC with subsequent risk of cardiovascular disease (CVD) and all-cause mortality in this population. Objectives To study the prospective association of CAC with risk of CVD and all-cause mortality among patients with pre-dialysis CKD. Design, Setting, and Participants Chronic Renal Insufficiency Cohort study recruited adults aged 21–74 years with an estimated-glomerular filtration rate (eGFR) of 20–70 mL/min/1.73 m2 from seven clinical centers in the US. Of them, 1,541 participants without CVD at baseline who had CAC measures were included in current analyses. Exposure CAC was assessed by electron-beam computed tomography or multi-detector computed tomography. Main Outcomes and Measures Incidence of CVD (including myocardial infarction, heart failure, and stroke) and all-cause mortality were reported every six months and confirmed by medical record adjudication. Results During an average of 5.9 years of follow-up, we observed 188 CVD (60 myocardial infarction, 120 heart failure, and 27 stroke) and 137 deaths. In Cox proportional hazards models adjusted for age, gender, race, clinical site, education, physical activity, total cholesterol, HDL-cholesterol, systolic blood pressure, antihypertensive treatment, current cigarette smoking, diabetes, body-mass index, C-reactive protein, hemoglobin A1c, phosphate, troponin T, log-N-terminal pro-B-type natriuretic peptide, fibroblast growth factor-23, eGFR, and proteinuria, the hazard ratios (95% confidence interval [CI]) associated with one standard deviation of CAC were 1.40 (1.16 to 1.69, p<.001) for CVD, 1.44 (1.02 to 2.02, p=.04) for myocardial infarction, 1.39 (1.10 to 1.76, p=.006) for heart failure, and 1.19 (0.94 to 1.51, p=.15) for all-cause mortality. In addition, inclusion of CAC score led to significant increase in c-statistic 0.02 (95% CI 0.00 to 0.09, p<.001) for predicting CVD over all above-mentioned established and novel CVD risk factors. Conclusion and Relevance CAC is independently and significantly related to the risks of CVD, myocardial infarction, and heart failure in CKD patients. In addition, CAC improves risk prediction for CVD, myocardial infarction, and heart failure over established and novel CVD risk factors among CKD patients, although the change in c-statistics is small.

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Section: Discussionmentioning

confidence: 54%

Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease

et al. 2017

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“…(29–36) In a study of 138 pre-transplant candidates and using a more lenient definition of significant CAD, defined as ≥ 50% diameter stenosis, Winther et al found the sensitivity and specificity of SPECT-MPI to be 53% and 82%, respectively. (37) The reason for the relatively low diagnostic performance of SPECT-MPI in this population is multifold. First, ESRD patients have a predisposition for particular hemodynamic and anatomic abnormalities which could impair diagnostic accuracy.…”

Section: Diagnostic Accuracy Of Spect-mpi In Esrdmentioning

confidence: 99%

“…Hybrid imaging techniques, such as coronary CTA/SPECT, have been shown to enhance diagnostic performance beyond either modality alone in renal transplant patients. (37) While the advantage of positron emission tomography (PET) as compared to SPECT-MPI has been well documented in the general population,(42) the diagnostic accuracy of PET-MPI specifically in ESRD patients has not been reported in the literature.…”

Section: Diagnostic Accuracy Of Spect-mpi In Esrdmentioning

confidence: 99%

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

Golzar

Doukky

2017

Curr Cardiovasc Imaging Rep

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Purpose of Review Patients with end-stage renal disease (ESRD) have an increased risk of cardiovascular morbidity and mortality. Cardiac risk assessment, though challenging, is critical in these high-risk patients, particularly in the pre-transplant population. In this review, we discuss the burden of coronary artery disease in the ESRD population and review the literature on the diagnostic and prognostic performance, clinical value, and future directions of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in ESRD patients. Recent Findings Stress myocardial perfusion imaging provides incremental prognostic value to clinical data. The AHA/ACCF consensus statement on the cardiac assessment of kidney transplant candidates provides some guidance on the selection of asymptomatic patients for further non-invasive risk stratification. Additionally, the novel selective A2A receptor agonist vasodilator stress agent, regadenoson, is safe and effective in ESRD and has recently been approved by the Food and Drug Administration for use in this population. Ancillary stress MPI findings, namely heart rate response to vasodilator stress, can provide incremental risk stratification. Summary While myocardial perfusion imaging is widely used as a risk assessment tool, its utilization and clinical implications in the ESRD population are controversial. Though stress SPECT-MPI has imperfect diagnostic accuracy in this specific patient population, it is still a valuable non-invasive modality in cardiovascular risk assessment.

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“…In a prospective study of 138 patients referred for pre-renal transplant cardiac evaluation (43% on dialysis) and underwent coronary artery calcium score, coronary computer tomography angiography, and SPECT, SPECT had a low sensitivity (53%) and modest specificity (82%) for detecting obstructive CAD (C50% stenosis). 15 Among patients with a normal SPECT, 14% of patients had obstructive CAD on invasive angiography. 15 Marwick et al found that while the sensitivity of dipyridamole thallium scintigraphy for detecting obstructive CAD was 95% in non-CKD control group, it was only 37% in dialysis patients even after matching for severity and extent of CAD.…”

Section: Stress Test In Ckd/esrd Patientsmentioning

confidence: 99%

“…15 Among patients with a normal SPECT, 14% of patients had obstructive CAD on invasive angiography. 15 Marwick et al found that while the sensitivity of dipyridamole thallium scintigraphy for detecting obstructive CAD was 95% in non-CKD control group, it was only 37% in dialysis patients even after matching for severity and extent of CAD. 16 In this study, the probability of obstructive CAD in patients with normal SPECT was 38%.…”

Section: Stress Test In Ckd/esrd Patientsmentioning

confidence: 99%

Stress testing in patients with chronic kidney disease: The need for ancillary markers for effective risk stratification and prognosis

Bangalore

2016

Journal of Nuclear Cardiology

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Diagnostic Performance of Coronary CT Angiography and Myocardial Perfusion Imaging in Kidney Transplantation Candidates

Cited by 89 publications

References 19 publications

Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease

Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

Stress testing in patients with chronic kidney disease: The need for ancillary markers for effective risk stratification and prognosis

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