The prognostic value of heart rate response during vasodilator stress myocardial perfusion imaging in patients with end-stage renal disease undergoing renal transplantation
- Clemenceau Medical Center, Division of Cardiovascular Medicine (Lebanon)
- Rush University Medical Center, Division of Cardiology (United States)
- Cook County Health and Hospitals System, Division of Cardiology (United States)
- Fairview Hospital, Department of Medicine (United States)
- Rush University Medical Center, Department of Radiology and Nuclear Medicine (United States)
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.
- OSTI ID:
- 22962080
- Journal Information:
- Journal of Nuclear Cardiology (Online), Vol. 26, Issue 3; Other Information: Copyright (c) 2019 American Society of Nuclear Cardiology; Country of input: International Atomic Energy Agency (IAEA); ISSN 1532-6551
- Country of Publication:
- United States
- Language:
- English
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