title: Coronary computed tomography angiography in dialysis patients undergoing pre-renal transplantation cardiac risk stratification.
abstract: BACKGROUND
  This study addresses the safety, feasibility, and interpretability of coronary computed tomography angiography (CCTA) in excluding significant coronary artery disease in end-stage renal disease patients on dialysis undergoing pre-renal transplant cardiac risk evaluation.
  
  
  METHODS
  Twenty nine patients (55.5 +/- 10.2 years) undergoing cardiac risk assessment prior to renal transplantation, underwent research CCTA with calcium scoring and formed the study group. All CCTAs were performed using retrospective acquisition, with beta-blockade provided one hour prior to scanning.
  
  
  RESULTS
  No major complications occurred in this group up to 30 days after CCTA. Of the total of 374 segments interpreted by both readers, only 36 (10%) were uninterpretable by both readers. Of these, 31 (86%) were from distal segments or branches. On a segmental level, there was 95% concordance between both readers for < 50% stenosis detection. Only three out of 28 (11%) CCTAs were deemed uninterpretable. Ten patients (36%) had zero calcium score, despite being on dialysis with no evidence of obstructive coronary artery disease by CCTA.
  
  
  CONCLUSIONS
  CCTA is feasible and safe in end-stage renal disease dialysis patients with the advent of 64-slice CCTA. Despite significant calcium burden, there was excellent inter-observer agreement at segment level for the left main and all three proximal-mid coronary arteries in excluding obstructive coronary artery disease (> 50% stenosis).
authors.affiliation: Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI 48202, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Mao
authors.forename: Vanji
authors.initials: V
authors.lastname: Karthikeyan
authors.forename: Chad
authors.initials: C
authors.lastname: Poopat
authors.forename: Thomas
authors.initials: T
authors.lastname: Song
authors.forename: Milan
authors.initials: M
authors.lastname: Pantelic
authors.forename: Joseph
authors.initials: J
authors.lastname: Chattahi
authors.forename: João L
authors.initials: JL
authors.lastname: Cavalcante
authors.forename: Karthik
authors.initials: K
authors.lastname: Ananthasubramaniam
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D006435:Renal Dialysis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000009:adverse effects