Prognostic impact of SPECT-MPI after renal transplantation.
While renal transplantation is increasingly performed for end-stage renal disease, there is a paucity of data on cardiac screening and prognostication post-transplant. We determined the prognostic value of SPECT-MPI in a cohort who underwent renal transplantation.



Among 4933 renal transplant recipients identified from the Canadian Organ Replacement Register, we examined outcomes of patients who underwent SPECT-MPI in Ontario, Canada. We determined morbidity and mortality using hospitalization and vital statistics registries, according to SPECT-MPI findings.



We studied 282 renal transplant recipients (median age 46 years [25th, 75th percentile 37, 58]) with detailed SPECT-MPI results available, followed for a median of 5.7 (3.3, 7.7) years. Among those undergoing SPECT-MPI (66% pharmacologic stress), 41% had an abnormal summed stress score (SSS > 0) and 31% demonstrated abnormal summed difference score (SDS > 0). Rates of cardiovascular death were 0.4 per 100 person-years among those with normal stress perfusion (SSS = 0) and 0.4 per 100 person-years with SDS = 0. After adjusting for age, sex, prior myocardial infarction (MI), and cardiac risk factors, an SSS ≥ 4 conferred increased risk of cardiovascular death or cardiovascular hospitalization with adjusted hazard ratios of 2.52 (95% CI 1.41, 4.52, P = .002) for SSS 4-6 and 2.61 (95% CI 1.52, 4.49, P < .001) for SSS ≥ 7. SDS was a significant predictor of cardiovascular death or hospitalization, with adjusted hazard ratios of 2.96 (95% CI 1.72, 5.09, P < .001) for SDS 4-6 and 3.26 (95% CI 1.64, 6.50, P < .001) for SDS ≥ 7.



Among renal transplant recipients, SPECT-MPI predicted risk of cardiovascular death and cardiovascular hospitalization events.
Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.|University of Toronto, Toronto, ON, Canada.
Wael
W
Abuzeid
Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.|University of Toronto, Toronto, ON, Canada.|Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
Robert M
RM
Iwanochko
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Xuesong
X
Wang
University of Toronto, Toronto, ON, Canada.|Division of Nephrology, University Health Network, Toronto, ON, Canada.
S Joseph
SJ
Kim
Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.|University of Toronto, Toronto, ON, Canada.|Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.|Ted Rogers Centre for Heart Research, Toronto, ON, Canada.
Mansoor
M
Husain
Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. dlee@ices.on.ca.|University of Toronto, Toronto, ON, Canada. dlee@ices.on.ca.|Robert J. Burns Nuclear Cardiology Laboratory and Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada. dlee@ices.on.ca.|Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. dlee@ices.on.ca.
Douglas S
DS
Lee
D000328:Adult; D059347:Cardio-Renal Syndrome / Q000000981:diagnostic imaging / Q000401:mortality; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*; D016896:Treatment Outcome
MIBI; MPI; Renal transplant recipients; SPECT
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