Pre-Operative Cardiovascular Testing and Post-Renal Transplant Clinical Outcomes.

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Citation: Cardiovascular Revascularization Medicine. 20(7):588-593, 2019 Jul.PMID: 31097384Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiac Catheterization | *Cardiac Imaging Techniques | *Cardiovascular Diseases/di [Diagnosis] | *Kidney Transplantation | *Preoperative Care | *Renal Insufficiency, Chronic/su [Surgery] | Adult | Aged | Cardiovascular Diseases/co [Complications] | Cardiovascular Diseases/mo [Mortality] | Cardiovascular Diseases/th [Therapy] | Cause of Death | Female | Humans | Kidney Transplantation/ae [Adverse Effects] | Kidney Transplantation/mo [Mortality] | Male | Middle Aged | Myocardial Revascularization | Predictive Value of Tests | Renal Insufficiency, Chronic/co [Complications] | Renal Insufficiency, Chronic/di [Diagnosis] | Renal Insufficiency, Chronic/mo [Mortality] | Retrospective Studies | Risk Assessment | Risk Factors | Time Factors | Treatment Outcome | Young AdultYear: 2019ISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: BACKGROUND: Cardiovascular disease, a major contributor to morbidity and mortality in chronic kidney disease and kidney transplant patients, is closely evaluated before kidney transplant. We aimed to characterize pre-transplant cardiac testing practices and post-transplant cardiac outcomes at a single academic center.CONCLUSIONS: Non-invasive functional testing is common prior to renal transplantation, with most being normal. Few patients are revascularized before transplantation. Perioperative death and acute coronary syndrome are rare, but troponin elevations due to type II NSTEMI and myocardial injury are common.Copyright (c) 2019 Elsevier Inc. All rights reserved.METHODS: This was a retrospective, single-center analysis of consecutive adults receiving first renal transplant from 1/1/2016 to 6/31/2017. Data included demographics, medical history, and medications. Pre-transplant workup included echocardiograms, cardiac stress testing, coronary computed tomography, left heart catheterization (LHC), and any revascularization. Outcomes included all-cause mortality, cardiac mortality, myocardial infarction (MI), and myocardial injury.RESULTS: Our analysis included 235 patients with mean follow-up of 1.6+/-0.53years. Of these, 219 (93%) patients had non-invasive functional testing before transplant, with 198 normal and 21 abnormal. The most common modalities were dobutamine stress echocardiogram (88) and pharmacological myocardial perfusion imaging (60). Twenty-four (10%) patients had an LHC, including 14 abnormal studies, and 10 who subsequently underwent successful revascularization. There were 3 deaths, 2 that were cardiac-specific. There were no ST-elevation MIs and 1 Type I non-ST-elevation MI (NSTEMI), occurring 2days after transplant. Of those patients with a 30-day post-operative troponin, 30 (13%) patients had an elevation due to a type II NSTEMI or myocardial injury.All authors: Ben-Dor I, Case BC, Gilbert AJ, Miller PJ, Rogers T, Satler LF, Waksman R, Widell JK, Yang MOriginally published: Cardiovascular Revascularization Medicine. 2019 Apr 17Fiscal year: FY2020Fiscal year of original publication: FY2019Digital Object Identifier: Date added to catalog: 2019-06-21
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Journal Article MedStar Authors Catalog Article 31097384 Available 31097384

BACKGROUND: Cardiovascular disease, a major contributor to morbidity and mortality in chronic kidney disease and kidney transplant patients, is closely evaluated before kidney transplant. We aimed to characterize pre-transplant cardiac testing practices and post-transplant cardiac outcomes at a single academic center.

CONCLUSIONS: Non-invasive functional testing is common prior to renal transplantation, with most being normal. Few patients are revascularized before transplantation. Perioperative death and acute coronary syndrome are rare, but troponin elevations due to type II NSTEMI and myocardial injury are common.

Copyright (c) 2019 Elsevier Inc. All rights reserved.

METHODS: This was a retrospective, single-center analysis of consecutive adults receiving first renal transplant from 1/1/2016 to 6/31/2017. Data included demographics, medical history, and medications. Pre-transplant workup included echocardiograms, cardiac stress testing, coronary computed tomography, left heart catheterization (LHC), and any revascularization. Outcomes included all-cause mortality, cardiac mortality, myocardial infarction (MI), and myocardial injury.

RESULTS: Our analysis included 235 patients with mean follow-up of 1.6+/-0.53years. Of these, 219 (93%) patients had non-invasive functional testing before transplant, with 198 normal and 21 abnormal. The most common modalities were dobutamine stress echocardiogram (88) and pharmacological myocardial perfusion imaging (60). Twenty-four (10%) patients had an LHC, including 14 abnormal studies, and 10 who subsequently underwent successful revascularization. There were 3 deaths, 2 that were cardiac-specific. There were no ST-elevation MIs and 1 Type I non-ST-elevation MI (NSTEMI), occurring 2days after transplant. Of those patients with a 30-day post-operative troponin, 30 (13%) patients had an elevation due to a type II NSTEMI or myocardial injury.

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