1. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Validation of a Clinical Pathway to Assess Asymptomatic Renal Transplant Candidates Using Myocardial Perfusion Imaging
Rami Doukky, MD, MSc, FASNC
Ibtihaj Fughhi, MD, MSc
Tania Campagnoli, MD, MSc
Marwan Wassouf, MD
Michael Kharouta, BS, MS
Aviral Vij, MD
Chiedozie Anokwute, MD
Andrew Appis, MD
Amjad Ali, MD
Copyright American Society of Nuclear Cardiology

2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
AHA/ACCF statement proposed 8 risk factors to assess the need for noninvasive CAD surveillance in asymptomatic patients undergoing kidney transplant evaluation:
These risk factors have not been clinically validated
The role of MPI in this context has not been defined
Age >60 y DM
Dyslipidemia
Dialysis >1 y
HTN
History of CVD
Smoking
LVH
Copyright American Society of Nuclear Cardiology

3. METHODS Study type: Retrospective cohort study
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
METHODS
Study type: Retrospective cohort study
Population: Consecutive 581 kidney transplant recipients
401 had pre-transplant SPECT-MPI
90 had pre-transplant coronary angiography
The sum of AHA/ACCF risk factors was calculated
Study endpoints:
Primary end point: obstructive CAD (≥ 70% or left main ≥ 50%)
Secondary end points: 1) 30-day post-operative MACE (cardiac death or MI); 2) long-term MACE
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4. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Discriminatory Capacity of the Sum of AHA/ACCF Risk Factors in Kidney Transplant Recipients
≥ 3 AHA/ACCF risk factors was an optimal threshold to predict study end points
Copyright American Society of Nuclear Cardiology

5. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Long-Term MACE Rates after Kidney Transplant Based on Clinical Risk and MPI Findings
MPI is most predictive of MACE in patients with 3 or 4 AHA/ACCF risk factors, following a Bayesian Model.
Copyright American Society of Nuclear Cardiology

6. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Impact of MPI Finding on Long-Term MACE-Free Survival after Kidney Transplant Based on Pre-Transplant AHA/ACCF Risk Factors
Abnormal
MPI
Ischemia
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7. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS
In asymptomatic kidney transplant candidates, the sum of the AHA/ACCF risk factors provides diagnostic and prognostic value
Having ≥3 risk factors defines patient with higher likelihood of obstructive CAD and at increased post-operative and long-term MACE risk
SPECT-MPI provides significant incremental diagnostic and long-term prognostic value to AHA/ACCF risk factors. Patients with 3-4 AHA/ACCF risk factors (intermediate risk), receive the greatest long-term prognostic value from MPI
Copyright American Society of Nuclear Cardiology