title: Myocardial perfusion is impaired in asymptomatic renal and liver transplant recipients: a cardiovascular magnetic resonance study.
abstract: BACKGROUND
  Myocardial ischemia is a major cause of death in chronic kidney disease (CKD) patients, which can be caused by either epicardial or microvascular coronary artery disease (CAD). Although renal transplantation improves survival, cardiovascular disease remains a major cause of mortality in post renal transplant recipients, including those with no significant epicardial CAD pre-transplant. We aim to utilize stress cardiovascular magnetic resonance (CMR) and MR coronary angiography (MRCA) to assess silent myocardial ischemia and epicardial CAD in renal transplant recipients.
  
  
  METHODS
  Forty-five subjects: twenty renal transplant (RT) with no known CAD, fifteen liver transplant (LT) controls without prior CKD and no known CAD, and ten hypertensive (HT) controls underwent stress perfusion CMR and MRCA.
  
  
  RESULTS
  A total of 1308 myocardial segments (576 of RT, 468 of LT, and 264 of HT) were compared using mixed linear modeling. Left ventricular mass index, septal diameter and presence of diabetes mellitus were similar between the groups. The mean transmural MPRI was significantly lower in the RT and LT groups compared to HT controls (1.19 ± 0.50 in RT versus 1.23 ± 0.36 in LT versus 2.04 ± 0.32 in HT controls, p < 0.0001), in the subepicardium (1.33 ± 0.57 in RT versus 1.30 ± 0.33 in LT versus 2.01 ± 0.30 in HT controls, p < 0.001), and in the subendocardium (1.19 ± 0.54 in RT versus 1.11 ± 0.31 in LT versus 1.85 ± 0.34 in HT controls, p < 0.0001). Seven (35%) RT and five (33%) LT had significant epicardial CAD compared to none in HT controls, p = 0.12. One RT and one LT had LGE suggesting sub-endocardial infarction.
  
  
  CONCLUSIONS
  RT recipients have impaired myocardial perfusion independent of LVH or diabetes mellitus. The impaired myocardial perfusion in RT is similar to LT without prior renal disease, thus unlikely related to previous CKD. It is not fully explained by the presence of significant epicardial CAD, and therefore most likely represents microvascular CAD.
authors.affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia. Joseph.Selva@health.sa.gov.au.|School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia. Joseph.Selva@health.sa.gov.au.
authors.forename: Susie
authors.initials: S
authors.lastname: Parnham
authors.affiliation: Department of Renal Medicine, Bedford Park, Adelaide, SA, Australia. Joseph.Selva@health.sa.gov.au.|School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia. Joseph.Selva@health.sa.gov.au.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Gleadle
authors.affiliation: School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia. Joseph.Selva@health.sa.gov.au.|Population Health Research Institute, Hamilton, ON, Canada. Joseph.Selva@health.sa.gov.au.
authors.forename: Darryl
authors.initials: D
authors.lastname: Leong
authors.affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia. Joseph.Selva@health.sa.gov.au.
authors.forename: Suchi
authors.initials: S
authors.lastname: Grover
authors.affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia. Joseph.Selva@health.sa.gov.au.
authors.forename: Craig
authors.initials: C
authors.lastname: Bradbrook
authors.affiliation: Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia. Joseph.Selva@health.sa.gov.au.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Woodman
authors.affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia. Joseph.Selva@health.sa.gov.au.|School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia. Joseph.Selva@health.sa.gov.au.
authors.forename: Carmine G
authors.initials: CG
authors.lastname: De Pasquale
authors.affiliation: Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, SA, 5042, Australia. Joseph.Selva@health.sa.gov.au.|School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia. Joseph.Selva@health.sa.gov.au.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Selvanayagam
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome