Coronary computed tomography angiography in dialysis patients undergoing pre-renal transplantation cardiac risk stratification

• Published in: Cardiology journal Vol. 17; no. 4; pp. 349 - 361
• Main Authors: Mao, Justin, Karthikeyan, Vanji, Poopat, Chad, Song, Thomas, Pantelic, Milan, Chattahi, Joseph, Cavalcante, João L, Ananthasubramaniam, Karthik
• Format: Journal Article
• Language: English
• Published: Poland Wydawnictwo Via Medica 2010
• Subjects: Aged; Cardiovascular disease; Chi-Square Distribution; Coronary Angiography - adverse effects; Coronary Angiography - methods; Coronary Stenosis - complications; Coronary Stenosis - diagnostic imaging; Coronary vessels; Echocardiography, Stress; Feasibility Studies; Female; Hemodialysis; Humans; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - surgery; Kidney Failure, Chronic - therapy; Kidney Transplantation - adverse effects; Male; Medical imaging; Michigan; Middle Aged; Observer Variation; Pilot Projects; Predictive Value of Tests; Preoperative Care; Prospective Studies; Renal Dialysis; Reproducibility of Results; Risk Assessment; Risk Factors; Severity of Illness Index; Tomography; Tomography, X-Ray Computed - adverse effects; Transplants & implants
• ISSN: 1897-5593; 1897-5593; 1898-018X

This study addresses the safety, feasibility, and interpretability of coronary computed tomography angiography (CCTA) in excluding significant coronary artery disease in end-stage renal disease patients on dialysis undergoing pre-renal transplant cardiac risk evaluation. Twenty nine patients (55.5 +/- 10.2 years) undergoing cardiac risk assessment prior to renal transplantation, underwent research CCTA with calcium scoring and formed the study group. All CCTAs were performed using retrospective acquisition, with beta-blockade provided one hour prior to scanning. No major complications occurred in this group up to 30 days after CCTA. Of the total of 374 segments interpreted by both readers, only 36 (10%) were uninterpretable by both readers. Of these, 31 (86%) were from distal segments or branches. On a segmental level, there was 95% concordance between both readers for < 50% stenosis detection. Only three out of 28 (11%) CCTAs were deemed uninterpretable. Ten patients (36%) had zero calcium score, despite being on dialysis with no evidence of obstructive coronary artery disease by CCTA. CCTA is feasible and safe in end-stage renal disease dialysis patients with the advent of 64-slice CCTA. Despite significant calcium burden, there was excellent inter-observer agreement at segment level for the left main and all three proximal-mid coronary arteries in excluding obstructive coronary artery disease (> 50% stenosis).