Warren Alpert Medical School, Brown University, Providence, RI, United States of America.
Cardiovascular Institute, The Warren Alpert Medical School at Brown University, Providence, RI, United States of America.
PLoS One. 2021 Dec 2;16(12):e0260718. doi: 10.1371/journal.pone.0260718. eCollection 2021.
Cardiovascular risk stratification is often performed in patients considered for renal transplantation. In a single center, we sought to examine the association between abnormal stress testing with imaging and post-renal transplant major adverse cardiovascular events (MACE) using multivariable logistic regression. From January 2006 to May 2016 232 patients underwent renal transplantation and 59 (25%) had an abnormal stress test result. Compared to patients with a normal stress test, patients with an abnormal stress test had a higher prevalence of dyslipidemia, diabetes mellitus, obesity, coronary artery disease (CAD), and heart failure. Among those with an abnormal result, 45 (76%) had mild, 10 (17%) moderate, and 4 (7%) severe ischemia. In our cohort, 9 patients (3.9%) had MACE at 30-days post-transplant, 5 of whom had an abnormal stress test. The long-term MACE rate, at a median of 5 years, was 32%. After adjustment, diabetes (OR 2.37, 95% CI 1.12-5.00, p = 0.02), CAD (OR: 3.05, 95% CI 1.30-7.14, p = 0.01) and atrial fibrillation (OR: 5.86, 95% CI 1.86-18.44, p = 0.002) were independently associated with long-term MACE, but an abnormal stress test was not (OR: 0.83, 95% CI 0.37-1.92, p = 0.68). In conclusion, cardiac stress testing was not an independent predictor of long-term MACE among patients undergoing renal transplant.
心血管风险分层通常在考虑肾移植的患者中进行。在单中心，我们试图使用多变量逻辑回归检查异常影像学应激试验与肾移植后主要不良心血管事件（MACE）之间的关系。2006 年 1 月至 2016 年 5 月，232 例患者接受了肾移植，其中 59 例（25%）应激试验结果异常。与应激试验正常的患者相比，应激试验异常的患者血脂异常、糖尿病、肥胖、冠心病（CAD）和心力衰竭的患病率更高。在异常结果中，45 例（76%）为轻度、10 例（17%）为中度、4 例（7%）为重度缺血。在我们的队列中，9 例（3.9%）患者在移植后 30 天发生 MACE，其中 5 例应激试验异常。中位数为 5 年的长期 MACE 发生率为 32%。调整后，糖尿病（OR 2.37，95%CI 1.12-5.00，p=0.02）、CAD（OR：3.05，95%CI 1.30-7.14，p=0.01）和心房颤动（OR：5.86，95%CI 1.86-18.44，p=0.002）与长期 MACE 独立相关，但应激试验异常无关（OR：0.83，95%CI 0.37-1.92，p=0.68）。总之，心脏应激试验不是肾移植患者长期 MACE 的独立预测因素。
