Validation of a clinical pathway to assess asymptomatic renal transplant candidates using myocardial perfusion imaging

Doukky, Rami; Fughhi, Ibtihaj; Campagnoli, Tania; Wassouf, Marwan; Kharouta, Michael; Vij, Aviral; Anokwute, Chiedozie; Appis, Andrew; Ali, Amjad

doi:10.1007/s12350-017-0901-4

Cited by 33 publications

(27 citation statements)

References 24 publications

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“…The study also confirmed that the presence of 3 or more of these risk factors is an effective threshold to use in order to derive a significant incremental predictive value from stress MPI in this population. (14)…”

Section: Cardiovascular Risk Stratification For Esrd Patientsmentioning

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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Section: Cardiovascular Risk Stratification For Esrd Patientsmentioning

confidence: 99%

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

Golzar

Doukky

2017

Curr Cardiovasc Imaging Rep

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“…In 2012, the American Heart Association and the American College of Cardiology Foundation (AHA/ACCF) published a scientific statement regarding cardiac evaluation in kidney and liver transplantation candidates. The statement indicates that “noninvasive stress testing may be considered in liver transplantation candidates with no active cardiac conditions on the basis of the presence of multiple CAD risk factors regardless of functional status.” [8, 9] These risk factors include age > 60 years, prior cardiovascular disease, hypertension, dyslipidemia, diabetes mellitus, smoking, and left ventricular hypertrophy [8]. The burden of these risk factors that should prompt non-invasive stress testing in asymptomatic patients has yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

The diagnostic and prognostic utility of risk factors defined by the AHA/ACCF on the evaluation of cardiac disease in liver transplantation candidates

Alexander

Teshome

Patel

et al. 2019

BMC Cardiovasc Disord

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Background The diagnostic and prognostic utility of risk factors proposed by the 2012 American Heart Association and American College of Cardiology Foundation (AHA/ACCF) Scientific Statement on the cardiac assessment of asymptomatic liver transplantation candidates have not been validated. We investigated whether the sum of risk factors proposed by the AHA/ACCF can identify liver transplant candidates at increased cardiac risk. Methods In a retrospective cohort of consecutive liver transplantation recipients, we calculated, for each subject, the pre-transplantation sum of AHA/ACCF risk factors (age > 60 years, prior cardiovascular disease, hypertension, dyslipidemia, diabetes mellitus, smoking, and left ventricular hypertrophy). The primary outcome was the presence of severe coronary artery disease (CAD), defined as ≥70% stenosis or ≥ 50% left main stenosis on pre-transplantation angiography. The secondary outcomes were the composite of cardiac death or myocardial infarction (MI) and the composite of cardiac death, MI, or coronary revascularization. Results Among 220 liver transplant recipients, the sum of AHA/ACCF risk factors had good discriminatory capacity for severe CAD [area under the curve, 0.77; 95% confidence interval (CI), 0.62–0.92; P = 0.007]; having ≥3 risk factors provided 75% sensitivity and 77% specificity for severe CAD. During mean post-transplantation follow-up of 48 ± 31 months, having ≥3 risk factors was associated with increased risk of the secondary composite outcomes of cardiac death or MI [hazard ratio, 2.39; P = 0.044] and cardiac death, MI, or coronary revascularization [hazard ratio, 2.39; P = 0.044]. Conclusions In patients undergoing cardiac assessment prior to liver transplantation, the sum of risk factors proposed by the AHA/ACCF provides significant diagnostic and prognostic utility. Having ≥3 AHA/ACCF risk factors is a reasonable threshold to prompt non-invasive stress testing in asymptomatic liver transplantation candidates.

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“…Standardization of medical treatment with implementation of clinical pathways is taking place in many health domains . In urology, the clinical pathways only regard cancer treatment and have all optimized the care of patients .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the impact of a clinical pathway on the progression of acute urinary retention

Gas

Liaigre-Ramos

Caubet-Kamar

et al. 2018

Neurourology and Urodynamics

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Aims: The management of acute urinary retention (AUR) revolves around trial without catheter (TWOC) after prescription of an alpha-blocker. This study evaluates the implementation of a clinical pathway for AUR. Methods: Specific clinical pathways for AUR was established between the Emergency Department and the Department of Urology in order to reduce the duration of bladder drainage that included standard prescriptions, an information sheet, and a note to be faxed to scheduling nurses to organize the trial without catheter (TWOC). The main endpoint was the reduction in the time between the AUR episode and TWOC, without decreasing urination. Results: Between April 2015 and December 2016, 248 patients were treated in the Emergency Department, and externally, for AUR. One hundred and seventy patients were enrolled in the pathway group and 78 in the control group. The mean duration of urinary catheterization decreased by 5.5 days as did the number of patients lost to follow-up (32% vs 76%), without decreasing the successful voiding (46% vs 36%). The duration of the urinary catheterization was not related to the chance of successful voiding regardless of the urine volume and a drainage time of over 10 days significantly reduced the chance of success (68%, n = 26 versus 42%, n = 76; P = 0.0038). Conclusion:The implementation of a clinical pathway for AUR reduced the number of patients lost to follow-up and the catheterization duration, thus optimizing the management of these patients. K E Y W O R D Sacute urinary retention, alpha-blocker, catheter removal, clinical pathway, emergency

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Validation of a clinical pathway to assess asymptomatic renal transplant candidates using myocardial perfusion imaging

Abstract: Asymptomatic kidney transplant candidates with ≥3 AHA/ACCF risk factors are at increased cardiac risk, and should be considered for noninvasive CAD surveillance. Intermediate risk patients (3-4 factors) benefit the most from pre-transplant MPI to define long-term MACE risk.

Cited by 33 publications

References 24 publications

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

The diagnostic and prognostic utility of risk factors defined by the AHA/ACCF on the evaluation of cardiac disease in liver transplantation candidates

Evaluation of the impact of a clinical pathway on the progression of acute urinary retention

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