title: Diagnostic Performance of Coronary CT Angiography and Myocardial Perfusion Imaging in Kidney Transplantation Candidates.
abstract: OBJECTIVE
  The goal of this study was to compare the diagnostic accuracy of the coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and a combination of these tools in the diagnosis of obstructive coronary artery disease (CAD) in patients with chronic kidney disease referred for cardiac evaluation before kidney transplantation.
  
  
  BACKGROUND
  The optimal method for the detection of obstructive CAD in potential kidney transplant patients has not yet been identified. Previous studies have found that established noninvasive stress tests have low diagnostic accuracy, while the diagnostic performance of coronary CTA remains unknown.
  
  
  METHODS
  We prospectively studied 138 patients referred for pre-transplant cardiac evaluation (mean age 54 years; age range 22 to 72 years; 68% male; 43% treated with dialysis). All patients underwent CACS, coronary CTA, SPECT, and invasive coronary angiography. The results of the noninvasive tests were merged into integrated hybrid imaging results: Hybrid (CACS/SPECT) and Hybrid (coronary CTA/SPECT).
  
  
  RESULTS
  The overall prevalence of obstructive CAD (≥50% reduction in luminal diameter) according to quantitative invasive coronary angiography was 22%. Two-thirds of the patients with obstructive CAD had a stenosis located in a proximal coronary segment. In a patient-level model, the sensitivity and specificity, respectively, for diagnosing obstructive CAD were as follows: CACS (threshold of 400), 67% and 77%; coronary CTA, 93% and 63%; SPECT, 53% and 82%; Hybrid (CACS/SPECT), 33% and 97%; and Hybrid (coronary CTA/SPECT), 67% and 86%. The sensitivity for diagnosing obstructive CAD in a proximal segment was 70% for CACS (threshold 400), 100% for coronary CTA, 60% for SPECT, 40% for Hybrid (CACS/SPECT), and 75% for Hybrid (coronary CTA/SPECT).
  
  
  CONCLUSIONS
  Coronary CTA is a reliable test with high sensitivity and a high negative predictive value for diagnosing obstructive CAD before kidney transplantation. A noninvasive approach with use of either coronary CTA or a combination of coronary CTA and SPECT to rule out obstructive CAD seems recommendable in kidney transplant candidates. (ACToR-Study: Angiographic CT of Renal Transplantation Candidate-Study; NCT01344434).
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: sw@dadlnet.dk.
authors: Simon
authors: S
authors: Winther
authors: Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
authors: My
authors: M
authors: Svensson
authors: Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
authors: Hanne Skou
authors: HS
authors: Jørgensen
authors: Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Denmark.
authors: Kirsten
authors: K
authors: Bouchelouche
authors: Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Denmark.
authors: Lars Christian
authors: LC
authors: Gormsen
authors: Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark.
authors: Birgitte Bang
authors: BB
authors: Pedersen
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Niels Ramsing
authors: NR
authors: Holm
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors: Hans Erik
authors: HE
authors: Bøtker
authors: Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
authors: Per
authors: P
authors: Ivarsen
authors: Department of Internal Medicine, Hospital Unit West, Herning, Denmark.
authors: Morten
authors: M
authors: Bøttcher
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D018579:Patient Selection; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: coronary angiography; coronary computed tomography angiography; renal transplantation; sensitivity and specificity; single-photon emission computed tomography