The utility of myocardial perfusion imaging before renal transplantation
| Autor: | Ann C. Tweddel, Sunil Bhandari, Andrew L. Clark, Paul D. Callan, Emmanouil Papadopoulos, David Eadington |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty 030232 urology & nephrology 030204 cardiovascular system & hematology 03 medical and health sciences Myocardial perfusion imaging 0302 clinical medicine Stress Physiological Internal medicine medicine Retrospective analysis Humans Radiology Nuclear Medicine and imaging Kidney transplantation Retrospective Studies medicine.diagnostic_test business.industry Hazard ratio Myocardial Perfusion Imaging Retrospective cohort study General Medicine Middle Aged medicine.disease Kidney Transplantation SSS Transplantation Cardiology Female business Perfusion |
| Zdroj: | Nuclear Medicine Communications. 39:228-235 |
| ISSN: | 0143-3636 |
| DOI: | 10.1097/mnm.0000000000000793 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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