Purpose.
Cardiac screening in adult kidney transplant candidates with myocardial perfusion scintigraphy (MPS)
can reveal findings associated with increased risk for coronary heart disease events, but the exact value of this
screening test is still undetermined.
Methods.
Narrative review based on the available literature and guidelines on the yield, benefits, and harms of
MPS screening in kidney transplant candidates.
Results.
Although coronary angiography carries low risk in general population, it is not without risk particularly in patients with complex comorbid disease and the use of intravenous contrast media may precipitate
a need for hospitalization and death. We could avoid invasive coronary angiography in patients with chronic
kidney disease, although with high coronary calcium score, but good left ventricle function and normal perfusion, evaluated by Gated single-photon emission computed tomographic (SPECT) MPS. In fact, although
Gated SPECT MPS has not a high sensitivity, it provides some variables that are closely related to sudden
death: post-stress and rest-ejection fraction and left ventricular volumes, left ventricle muscle mass, extent
of ischemia and scar.
Conclusions.
Gated SPECT MPS is a valid noninvasive cardiac screening test. It can be used as alternative to stress
echocardiography in kidney transplant candidates with high cardiovascular risk and a positive or inconclusive
exercise tolerance ECG test.
Patients with abnormal perfusion and cardiac dysfunction should undergo invasive coronary artery imaging and
endovascular treatment, while angiography could be avoided in patients with normal MPI, having good long-term
prognosis.
Coronary artery disease, Kidney transplant, Myocardial scintigraphy
Financial support: No grants or funding have been received for this
study.
Alberto Bestetti Casa di Cura San Pio X Via Nava, 31 20159 Milano, Italy alberto.bestetti@unimi.it
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