title: Screening for silent ischemia with coronary artery calcium and nuclear stress testing in nondiabetic patients prior to kidney transplant.
abstract: Whether coronary artery calcium (CAC) screening in pretransplant patients may help predict silent myocardial ischemia is unknown. Accordingly, we performed CAC imaging on 46 nondiabetic patients awaiting kidneytransplant. All patients underwent multidetector computed tomography imaging for CAC quantification, and a vasodilator myocardial perfusion stress (MPS) test was performed only in patients with a total CAC score>300 or>100 in a single coronary artery. The mean patient's age was 46+/-14 years and the median dialysis vintage was 33 months (interquartile range 19-53). The median CAC score was 82 (interquartile range 0-700) and correlated with patients' age (p=0.006) and dialysis vintage (p=0.02). Nineteen patients qualified for MPS, but 5 refused the test. Of the remaining 14 patients, 7 patients had normal scans and 7 showed a minimal perfusion defect in the inferoposterior segment of the left ventricle. At the time of writing, 12 patients have undergone successful kidney transplantation without untoward complications. CAC screening does not appear to be associated with silent ischemia in pretransplant patients. Though CAC is extensive in dialysis patients, calcium may be associated with nonobstructive atherosclerotic lesions or calcification of the media layer of the vessel wall.
authors.affiliation: Division of Nephrology, Dialysis and Renal Transplantation, Ospedale Policlinico and University of Modena, Modena, Italy.
authors.forename: Emiliana
authors.initials: E
authors.lastname: Ferramosca
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Felice
authors.forename: Carlo
authors.initials: C
authors.lastname: Ratti
authors.forename: Guido
authors.initials: G
authors.lastname: Ligabue
authors.forename: Dalia
authors.initials: D
authors.lastname: Ibrahim
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.forename: Bruno
authors.initials: B
authors.lastname: Bagni
authors.forename: Alberto
authors.initials: A
authors.lastname: Albertazzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Raggi
mesh_terms: D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000175:diagnosis*; D003327:Coronary Disease / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011877:Radionuclide Imaging