1. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
The Prognostic value of Heart Rate Response during Vasodilator Stress Myocardial Perfusion Imaging in Patients with End-Stage Renal Disease Undergoing Renal Transplantation
Wael AlJaroudi, MD, MSc, FASNC
Chiedozie Anokwute, MD
Ibtihaj Fughhi, MD, MSc
Tania Campagnoli, MD, MSc
Marwan Wassouf, MD
Michael Kharouta, BS, MS
Aviral Vij, MD
Andrew Appis, MD
Amjad Ali, MD
Rami Doukky, MD, MSc, FASNC
Head shot of author
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2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
Blunted heart rate response (HRR) to vasodilator stress in end-stage renal disease (ESRD) patients undergoing myocardial perfusion imaging (MPI) was shown to be associated with worse outcomes.
However, all the studies performed in ESRD patients, either censored events at renal transplantation (RT) or did not account for the impact of RT on subsequent outcomes.
The impact of pre-transplant HRR on long-term outcomes after RT remains unknown.
We sought to assess whether HRR to vasodilator stress pre-RT can predict outcomes post-RT.
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3. METHODS Design: Retrospective cohort study Study subjects:
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
METHODS
Design: Retrospective cohort study
Study subjects:
Consecutive patients with ESRD, RT recipients (2005 and 2015) who underwent a vasodilator stress SPECT-MPI as part of pre-RT work-up
Blunted HRR was defined as HRR <28% for regadenoson stress and <20% for adenosine stress
Clinical risk was assessed using the risk factors set-forth by the AHA/ACCF statement on the assessment of RT candidates (age > 60 years, hypertension, diabetes, dyslipidemia, smoking, cardiovascular disease, dialysis > 1 year, left ventricular hypertrophy).
Study end points:
Primary end point: Major adverse cardiac events (MACE), defined as cardiac death or MI.
Secondary end points:
1. Post-operative MACE, within 30 days after RT
2. All-cause death after RT
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4. Impact of Blunted HRR on Outcomes after Renal Transplant
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Impact of Blunted HRR on Outcomes after Renal Transplant
HRR, heart rate response; MACE, major adverse cardiac events (cardiac death or myocardial infarction); Post-Op MACE, MACE within 30 days after renal transplant
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5. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Impact of blunted HRR on MACE stratified by Myocardial Perfusion Imaging
HRR, heart rate response, MPI, myocardial perfusion imaging, SSS, summed stress score
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6. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Impact of blunted HRR on MACE stratified by the Sum of AHA/ACCF risk factors
AHA/ACCF risk factors: age ≥ 60 years, hypertension, diabetes, hyperlipidemia, smoking, left ventricular hypertrophy, history of cardiovascular disease, dialysis ≥ 1 year
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7. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS
In ESRD patients being evaluated for RT, a blunted pre-transplant HRR was predictive of post-RT MACE, post-operative MACE independent of traditional risk factors, and provided incremental prognostic value.
HRR may be a valuable tool in the risk assessment of RT candidates.
Copyright American Society of Nuclear Cardiology