Myocardial Perfusion Scintigraphy Provides Incremental Prognostic Value in Patients on the Kidney Transplant Waiting List

Reuter, Stefan; Reiermann, Stefanie; Stypmann, Joerg; Bautz, Joachim; Schuette-Nuetgen, Katharina; Pavenstaedt, Hermann; Malyar, Viola; Reinecke, Holger; Kurosinski, Marc-Andre; Goerlich, Dennis; Hense, Hans-Werner; Suwelack, Barbara; Schaefers, Michael

Abstract

The approach to cardiovascular risk assessment before renal transplantation is still controversial. Therefore, we evaluated and compared the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) who are candidates for kidney transplantation (KTx). Methods: We prospectively enrolled 356 ESRD clinical transplantations for review, only patients (NCT01064674) admitted to our transplant center between August 2009 and July 2012. Cardiovascular risk assessment at the time of listing was based on the Münster Cardiovascular Risk Stratification Score (MCRSS), additionally including evaluation by DSE and MPS in all ESRD patients. Coronary angiography was conducted in patients at high risk according to the MCRSS and in those where noninvasive stress testing revealed stress-induced ischemia or wall motion abnormalities. Results: During long-term follow-up until October 2020, 2.43 cardiovascular events/100 person-years (nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) occurred, and the overall patient survival was 71.9%. Mild perfusion deficits identified by MPS, unlike wall motion abnormalities detected by DSE, showed incremental prognostic value for event-free survival in patients with low MCRSS risk. Conclusion: We therefore propose a modified MCRSS-based approach including MPS as a reasonable risk stratification approach for cardiovascular risk assessment of ESRD patients applying for KTx.