Abstract
BackgroundMyocardial ischemia is a major cause of death in chronic kidney disease (CKD) patients, which can be caused by either epicardial or microvascular coronary artery disease (CAD). Although renal transplantation improves survival, cardiovascular disease remains a major cause of mortality in post renal transplant recipients, including those with no significant epicardial CAD pre-transplant. We aim to utilize stress cardiovascular magnetic resonance (CMR) and MR coronary angiography (MRCA) to assess silent myocardial ischemia and epicardial CAD in renal transplant recipients.MethodsForty-five subjects: twenty renal transplant (RT) with no known CAD, fifteen liver transplant (LT) controls without prior CKD and no known CAD, and ten hypertensive (HT) controls underwent stress perfusion CMR and MRCA.ResultsA total of 1308 myocardial segments (576 of RT, 468 of LT, and 264 of HT) were compared using mixed linear modeling. Left ventricular mass index, septal diameter and presence of diabetes mellitus were similar between the groups. The mean transmural MPRI was significantly lower in the RT and LT groups compared to HT controls (1.19 ± 0.50 in RT versus 1.23 ± 0.36 in LT versus 2.04 ± 0.32 in HT controls, p < 0.0001), in the subepicardium (1.33 ± 0.57 in RT versus 1.30 ± 0.33 in LT versus 2.01 ± 0.30 in HT controls, p < 0.001), and in the subendocardium (1.19 ± 0.54 in RT versus 1.11 ± 0.31 in LT versus 1.85 ± 0.34 in HT controls, p < 0.0001). Seven (35 %) RT and five (33 %) LT had significant epicardial CAD compared to none in HT controls, p = 0.12. One RT and one LT had LGE suggesting sub-endocardial infarction.ConclusionsRT recipients have impaired myocardial perfusion independent of LVH or diabetes mellitus. The impaired myocardial perfusion in RT is similar to LT without prior renal disease, thus unlikely related to previous CKD. It is not fully explained by the presence of significant epicardial CAD, and therefore most likely represents microvascular CAD.
Highlights
Myocardial ischemia is a major cause of death in chronic kidney disease (CKD) patients, which can be caused by either epicardial or microvascular coronary artery disease (CAD)
Subject characteristics Forty-five subjects participated in the study: twenty renal transplant (RT), fifteen liver transplant (LT) controls, and ten HT controls participated in the study
Using Bonferroni correction for multiple group comparison, the Estimated glomerular filtration rate (eGFR) was lower in the renal transplant group compared to hypertensive control (p = 0.012), but similar compared to liver transplant group (p = 0.67)
Summary
Myocardial ischemia is a major cause of death in chronic kidney disease (CKD) patients, which can be caused by either epicardial or microvascular coronary artery disease (CAD). We aim to utilize stress cardiovascular magnetic resonance (CMR) and MR coronary angiography (MRCA) to assess silent myocardial ischemia and epicardial CAD in renal transplant recipients. Cardiovascular disease is the leading cause of mortality and morbidity in the chronic kidney disease (CKD) population, accounting for 50 % of all deaths [1]. Parnham et al Journal of Cardiovascular Magnetic Resonance (2015) 17:56 of myocardial function, perfusion and irreversible injury with high spatial resolution [5]. Stress perfusion CMR has high sensitivity and negative predictive value for detecting myocardial ischemia with a sensitivity of 89 % and a specificity of 80 % [6]. CMR allows accurate quantification of ventricular function and mass as well as tissue characterization, thereby uniquely positioning it as a powerful modality to explore the high cardiovascular event rate in renal transplant patients
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