Department of Internal Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
Clin Transplant. 2020 Aug;34(8):e13894. doi: 10.1111/ctr.13894. Epub 2020 May 22.
The value of myocardial single-photon emission computed tomography (SPECT) in pre-transplant evaluation of kidney transplant recipients is controversial. We assessed whether myocardial SPECT predicts major adverse cardiac events (MACE) and determined whether SPECT findings affected transplant recipients' medical and invasive treatment. We analyzed 301 patients referred for myocardial SPECT before kidney transplantation and combined the results with information from patient files and the Transplantation Registry. During the median follow-up time of 96 months (IQR 70.75-118.25 months), the incidence of MACE was higher in patients (n = 37) with severely abnormal SPECT (>10% reversible perfusion defect) than in patients (n = 35) with mildly abnormal or normal SPECT (51.4%, 29.4%, and 27.0%, respectively, P = .011). Severely abnormal SPECT findings predicted long-term MACE in a univariable analysis but not after adjusting for other risk factors. Following SPECT, 29 patients (9.6%) underwent coronary angiography and 14 (4.6%) were revascularized. New antithrombotic or statin medication was prescribed to 7.3% of patients with ischemia in SPECT. Kidney transplantation patients are at high long-term risk of MACE even with normal preoperative myocardial SPECT. Abnormal SPECT did not predict MACE when adjusted for other risk factors. Minority of the patients underwent coronary revascularization or had changes in preventive medication before transplantation.
心肌单光子发射计算机断层扫描（SPECT）在肾移植受者移植前评估中的价值存在争议。我们评估了心肌 SPECT 是否可预测主要不良心脏事件（MACE），并确定 SPECT 结果是否影响移植受者的医疗和介入治疗。我们分析了 301 例在接受肾移植前进行心肌 SPECT 的患者，并将结果与患者档案和移植登记处的信息相结合。在中位数为 96 个月（IQR 70.75-118.25 个月）的随访期间，SPECT 严重异常（>10%可逆转灌注缺陷）患者（n=37）的 MACE 发生率高于 SPECT 轻度异常或正常患者（分别为 51.4%、29.4%和 27.0%，P=0.011）。单变量分析显示，SPECT 严重异常预测长期 MACE，但在调整其他危险因素后则不然。SPECT 后，29 例（9.6%）患者行冠状动脉造影，14 例（4.6%）患者行血运重建。SPECT 显示缺血的患者中有 7.3%接受了新的抗血栓或他汀类药物治疗。即使术前心肌 SPECT 正常，肾移植患者仍存在长期发生 MACE 的高风险。在调整其他危险因素后，异常 SPECT 并未预测 MACE。少数患者在移植前进行了冠状动脉血运重建或改变了预防用药。
