Abstract
1107
Objectives Patients evaluated for kidney transplantation (KT) are at high risk of atherosclerotic heart disease and future cardiac events. Current evidence for role of SPECT in pre KT patients is conflicting. We sought to identify if pharmacologic SPECT imaging can reliably predict major adverse cardiac events (MACE) in this population.
Methods A retrospective study of 116 patients who underwent SPECT prior to KT between 1/1/97 to 12/31/2008. Patients with revascularization after the SPECT but before the KT were excluded from the study. MACE studied were cardiac (CD), non-cardiac death (NCD), congestive heart failure (CHF) admissions, and non-fatal myocardial infarction (NFMI). SPECT results were classifed as normal, scar, ischemia, or scar and ischemia. Sensitivity, specificity, positive, and negative predictive values for long term MACE were calculated.
Results Patients with a SPECT prior to KT were on an average of 56 years of age, with 65 % males, and 47 % African-Americans. Diabetes was present in 51 %, hypertension in 95 %, 31% had CHF and 22 % had prior coronary artery disease. Adenosine and Dobutamine SPECT were performed in 76 % and 23% of patients respectively. Median follow up was 41.4 months. MPI-ST had a sensitivity of 30%, specificity of 93%, positive predictive value of 64%, and negative predictive value of 77% for predicting overall MACE. There was a significant difference in MACE outcomes between normal and scar groups (23.2% vs. 60.0% p < 0.024) and between normal and scar + ischemic groups (23.2% vs. 63.6% p < 0.011).
Conclusions Presence of either scar or scar and ischemia on pre KT SPECT predicts increased MACE in KT recipients over long term follow up. The accuracy of SPECT in the KT population is comparable to non-transplant patient subsets. Scar has important implications for MACE and identifies a patient subset requiring close monitoring and aggressive medical therapy. SPECT can be considered a first line test in pre-KT assessment