TY - JOUR
T1 - The prognostic value of heart rate response during vasodilator stress myocardial perfusion imaging in patients with end-stage renal disease undergoing renal transplantation
AU - AlJaroudi, Wael
AU - Anokwute, Chiedozie
AU - Fughhi, Ibtihaj
AU - Campagnoli, Tania
AU - Wassouf, Marwan
AU - Vij, Aviral
AU - Kharouta, Michael
AU - Appis, Andrew
AU - Ali, Amjad
AU - Doukky, Rami
N1 - Funding Information:
Funding The study was funded by an investigator-initiated grant from Astellas Pharma Global Development (Northbrook, IL). The grant fiduciary was Rush University Medical Center; the principal
Publisher Copyright:
© 2017, American Society of Nuclear Cardiology.
PY - 2019/6/15
Y1 - 2019/6/15
N2 - Background: In asymptomatic end-stage renal disease (ESRD) patients undergoing vasodilator stress myocardial perfusion imaging (MPI) prior to renal transplantation (RT), the impact of pre-transplant heart rate response (HRR) to vasodilator stress on post-RT outcomes is unknown. Methods: We analyzed a retrospective cohort of asymptomatic patients with ESRD who underwent a vasodilator stress SPECT-MPI and subsequently received RT. Blunted HRR was defined as HRR <28% for regadenoson stress and <20% for adenosine stress. The primary endpoint was major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. Clinical risk was assessed using the sum of risk factors set forth by the AHA/ACCF consensus statement on the assessment of RT candidates. Results: Among 352 subjects, 140 had an abnormal pre-transplant HRR. During a mean follow-up of 3.2 ± 2.0 years, 85 (24%) MACEs were observed. Blunted HRR was associated with increased MACE risk (hazard ratio 1.72; 95% confidence interval 1.12-2.63, P = 0.013), and remained significant after adjustment for gender, sum of AHA/ACCF risk factors, summed stress score, baseline heart rate, and β-blocker use. HRR was predictive of MACE in patients with normal MPI and irrespective of clinical risk. Blunted HRR was associated with a significant increase in post-operative (30-day) MACE risk (17.9% vs 8.5%; P = 0.009). Conclusion: In asymptomatic ESRD patients being evaluated for RT, a blunted pre-transplant HRR was predictive of post-RT MACE. HRR may be a valuable tool in the risk assessment of RT candidates.
AB - Background: In asymptomatic end-stage renal disease (ESRD) patients undergoing vasodilator stress myocardial perfusion imaging (MPI) prior to renal transplantation (RT), the impact of pre-transplant heart rate response (HRR) to vasodilator stress on post-RT outcomes is unknown. Methods: We analyzed a retrospective cohort of asymptomatic patients with ESRD who underwent a vasodilator stress SPECT-MPI and subsequently received RT. Blunted HRR was defined as HRR <28% for regadenoson stress and <20% for adenosine stress. The primary endpoint was major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. Clinical risk was assessed using the sum of risk factors set forth by the AHA/ACCF consensus statement on the assessment of RT candidates. Results: Among 352 subjects, 140 had an abnormal pre-transplant HRR. During a mean follow-up of 3.2 ± 2.0 years, 85 (24%) MACEs were observed. Blunted HRR was associated with increased MACE risk (hazard ratio 1.72; 95% confidence interval 1.12-2.63, P = 0.013), and remained significant after adjustment for gender, sum of AHA/ACCF risk factors, summed stress score, baseline heart rate, and β-blocker use. HRR was predictive of MACE in patients with normal MPI and irrespective of clinical risk. Blunted HRR was associated with a significant increase in post-operative (30-day) MACE risk (17.9% vs 8.5%; P = 0.009). Conclusion: In asymptomatic ESRD patients being evaluated for RT, a blunted pre-transplant HRR was predictive of post-RT MACE. HRR may be a valuable tool in the risk assessment of RT candidates.
KW - adenosine
KW - end-stage renal disease
KW - Heart rate response
KW - myocardial perfusion imaging
KW - prognosis
KW - regadenoson
KW - transplant
UR - http://www.scopus.com/inward/record.url?scp=85029584040&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85029584040&partnerID=8YFLogxK
U2 - 10.1007/s12350-017-1061-2
DO - 10.1007/s12350-017-1061-2
M3 - Article
C2 - 28924814
AN - SCOPUS:85029584040
SN - 1071-3581
VL - 26
SP - 814
EP - 822
JO - Journal of Nuclear Cardiology
JF - Journal of Nuclear Cardiology
IS - 3
ER -