Marwan Wassouf

THE PROGNOSTIC VALUE OF SERIAL STRESS MYOCARDIAL PERFUSION IMAGING IN ASYMPTOMATIC END-STAGE RENAL DISEASE PATIENTS AWAITING KIDNEY TRANSPLANTATION

Background: The role of serial SPECT myocardial perfusion imaging (MPI) for CAD surveillance in asymptomatic ESRD patients awaiting kidney transplantation (KT) is controversial. Methods: In a prospective cohort study, we analyzed consecutive asymptomatic KT candidates who had 2 MPI studies within 5

The prognostic value of heart rate response during vasodilator stress myocardial perfusion imaging in patients with end-stage renal disease undergoing renal transplantation

BackgroundIn 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.MethodsWe 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.ResultsAmong 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).ConclusionIn 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.

THE SAFETY AND TOLERABILITY OF REGADENOSON IN PATIENTS WITH END-STAGE RENAL DISEASE: THE FIRST PROSPECTIVE EVALUATION

Regadenoson (REG) appears to be safe in patients with end-stage renal disease (ESRD) on the basis of two retrospective studies. A prospective, placebo-controlled clinical trial by Palani et al found REG to be safe in chronic kidney disease (CKD) stage III-IV. However, there has not been a