Impact of pretransplant mitral annular calcification on the incidence of cardiac events after renal transplantation

2019 ◽  
Vol 35 (3) ◽  
pp. 526-533 ◽  
Author(s):  
Nadia El Hangouche ◽  
Javier Gomez ◽  
Addis Asfaw ◽  
Jayakumar Sreenivasan ◽  
Tauseef Akhtar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplantation ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Mitral Annular Calcification ◽  
Post Transplant ◽  
Increased Risk ◽  
Annular Calcification

Abstract Background Mitral annular calcification (MAC) is associated with increased risk of major adverse cardiac events. We hypothesized that MAC, identified on a pretransplant transthoracic echocardiography (TTE), is predictive of cardiac events following renal transplantation (RT). Methods In a retrospective cohort of consecutive RT recipients, pretransplant MAC presence and severity were determined on TTE performed within 1 year prior to transplant. MAC severity was quantified based on the circumferential MAC extension relative to the mitral valve annulus. Post-transplant cardiac risk was assessed using the sum of risk factors (range: 0–8) set forth by the American Heart Association/American College of Cardiology Foundation consensus statement on the assessment of RT candidates. Subjects underwent pretransplant stress single-photon emission computed tomography myocardial perfusion imaging and followed for post-transplant composite outcome of cardiac death or myocardial infarction (CD/MI). Results Among 336 subjects (60.5% men; mean age 52 ± 12 years), MAC was present in 78 (23%) patients. During a mean follow-up of 3.1 ± 1.9 years, a total of 70 events were observed. Patients with MAC had a higher event rate compared with those without MAC (34.6% versus 17.8%, log-rank P = 0.001). There was a stepwise increase in CD/MI risk with increasing MAC severity (P for trend = 0.002). MAC-associated risk remained significant after adjusting for sex, duration of dialysis, sum of risk factors, ejection fraction and perfusion abnormality burden, providing an incremental prognostic value to these parameters (Δχ2 =4.63; P = 0.031). Conclusion Among RT recipients, the burden of pretransplant MAC is an independent predictor of post-transplant risk of CD/MI. MAC should be considered in the preoperative assessment of RT candidates.

scholarly journals Risk Factors for Development of Coronary Heart Disease in Patients with Acromegaly: A Five-Year Prospective Study

2007 ◽  
Vol 92 (11) ◽  
pp. 4271-4277 ◽  
Author(s):  
Fausto Bogazzi ◽  
Luigi Battolla ◽  
Cheti Spinelli ◽  
Giuseppe Rossi ◽  
Silvia Gavioli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Cardiac Events ◽  
Chd Risk ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Abstract Background: Data on coronary heart disease (CHD) are scanty and matter of argument in acromegalic patients. Objective: The objective of this study was to evaluate risk factors for development of CHD and the occurrence of cardiac events in acromegalic patients during a 5-yr prospective study. Design: Ten-year likelihood for CHD development was estimated by the Framingham scoring system (FS); patients were stratified as having low (FS < 10), intermediate (≥ 10 FS < 20), or high (FS ≥ 20) risk. Coronary artery calcium content was measured using the Agatston score (AS) in all patients; those with positive AS were submitted to myocardial single-photon emission computed tomography; cardiac events were recorded during a 5-yr follow-up period. Patients: Fifty-two consecutive patients (31 women, mean age 52 ± 11 yr) with controlled or uncontrolled acromegaly were followed prospectively for 5 yr. Results: Thirty-seven patients (71%) had low, 14 patients (27%) had intermediate, and one patient (2%) had high CHD risk. CHD risk was unrelated to acromegaly activity or the estimated duration of disease. Among patients with FS less than 10%, 24 had AS equal to 0, eight had AS of 1 or greater and less than 100, and five had AS 100 or greater and less than 300, respectively. Among patients with FS 10 or greater and less than 20%, nine had AS equal to 0, two had AS of one or greater and less than 100, one had AS of 100 or greater and less than 300, and two had AS of 300 or greater; a patient of the latter group, having AS of 400 or greater, increased his CHD risk from 11% to 20% or more. FS or AS did not differ in patients with controlled or uncontrolled acromegaly (P = 0.981). All patients with positive AS had no single photon emission computed tomography perfusion defects. During the 5-yr follow-up period no patient developed ischemic cardiac events. Conclusions: CHD risk in acromegalic patients, predicted by FS as in nonacromegalic subjects, is low; AS might have adjunctive role only in a subset of patients. However, most patients have systemic complications of acromegaly, which participate in the assessment of global CHD risk.

Most Important Prognostic Values to Predict Major Adverse Cardiovascular, Cerebrovascular, and Renal Events in Patients with Chronic Kidney Disease Including Hemodialysis for 2 Years

Cardiology ◽  
2019 ◽  
Vol 142 (1) ◽  
pp. 14-23
Author(s):  
Takuji Toyama ◽  
Shu Kasama ◽  
Makito Sato ◽  
Hirokazu Sano ◽  
Tetsuya Ueda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Myocardial Perfusion ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
99Mtc Tetrofosmin ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Free Rate

Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular/cerebrovascular events. The aim of this study is to clarify whether stress myocardial perfusion single-photon emission computed tomography (SPECT) could predict cardiovascular/cerebrovascular events. In the Gunma-CKD SPECT Study, a multicenter prospective cohort trial, 311 patients with CKD (estimated glomerular filtration rate < 60 min/mL/1.73 m2) including 50 patients on hemodialysis underwent stress 99mTc-tetrofosmin SPECT for suspected ischemic heart disease and were followed for 2 years. The primary endpoint was the occurrence of cardiac death (CD), while the secondary endpoint was major adverse cardiovascular/cerebrovascular and renal events (MACCRE). MACCRE occurred in 91 out of 286 patients (CD in 13 and other MACCRE in 78 patients). According to a multivariate Cox analysis, hemoglobin (Hb) and end-systolic volume (ESV) were associated with CD (p < 0.05), while the summed difference score, diabetes mellitus (DM), and Hb were associated with MACCRE (p < 0.05). Kaplan-Meier analysis showed that the CD-free rate was higher in patients with ESV < 105 mL (log-rank, p = 0.0013), Hb > 12 g (log-rank, p = 0.0036), and a summed stress score < 6 (log-rank, p = 0.0058). The MACCRE-free rate was higher in patients with SDS = 0 (log-rank, p = 0.0097), without DM (log-rank, p = 0.0091), and with Hb > 12 g (log-rank, p = 0.0023). Myocardial perfusion SPECT parameters as well as renal anemia and DM can be reliable prognostic markers in patients with CKD including hemodialysis.

scholarly journals Psychological factors of suspect coronary microvascular dysfunction in patients undergoing SPECT imaging

2020 ◽  
Author(s):  
Maria T. Bekendam ◽  
Ilse A. C. Vermeltfoort ◽  
Willem J. Kop ◽  
Jos W. Widdershoven ◽  
Paula M. C. Mommersteeg
Keyword(s):  
Psychological Factors ◽  
Single Photon ◽  
Reference Group ◽  
Obstructive Coronary Artery Disease ◽  
Photon Emission ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Emission Computed Tomography ◽  
Cardiac Events ◽  
Inducible Ischemia

Abstract Background Patients with myocardial ischemia in the absence of obstructive coronary artery disease (CAD) often experience anginal complaints and are at risk of cardiac events. Stress-related psychological factors and acute negative emotions might play a role in these patients with suspect coronary microvascular dysfunction (CMD). Methods and Results 295 Patients (66.9 ± 8.7 years, 46% women) undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT), were divided as follows: (1) a non-ischemic reference group (n = 136); (2) patients without inducible ischemia, but with a history of CAD (n = 62); (3) ischemia and documented CAD (n = 52); and (4) ischemia and suspect CMD (n = 45). These four groups were compared with regard to psychological factors and acute emotions. Results revealed no differences between the groups in psychological factors (all P > .646, all effect sizes d < .015). State sadness was higher for patients with suspect CMD (16%) versus the other groups (P = .029). The groups did not differ in the association of psychological factors or emotions with anginal complaints (all P values > .448). Conclusion Suspect CMD was not associated with more negative psychological factors compared to other groups. State sadness was significantly higher for patients with suspect CMD, whereas no differences in state anxiety and other psychological factors were found.

Cardiac autonomic activity and Type II diabetes mellitus

2005 ◽  
Vol 108 (2) ◽  
pp. 93-99 ◽  
Author(s):  
Daniela MANZELLA ◽  
Giuseppe PAOLISSO
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Autonomic Function ◽  
Single Photon ◽  
Low Cost ◽  
Photon Emission ◽  
Cardiac Autonomic Neuropathy ◽  
Emission Computed Tomography ◽  
Published Data ◽  
Increased Risk

CAN (cardiac autonomic neuropathy) is a common complication of diabetes. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function, as measured by heart rate variability, is strongly associated with an increased risk of silent myocardial ischaemia and mortality. A major problem in ischaemia-induced impairment of vascular performance in the diabetic heart is unrecognized cardiac sympathetic dysfunction. Determining the presence of CAN is based on a battery of autonomic function tests and techniques such as SPECT (single-photon emission computed tomography) and PET (positron emission tomography). Nevertheless, spectral analysis of heart rate variability seems to remain the primary technique in evaluating CAN, due to its low cost, easy use and good intra-individual reproducibility.

Abstract 2481: Myocardial Viability Determined by Myocardial Contrast Echocardiography is Superior to 99m Technetium Sestamibi Single Photon Emission Computed Tomography in Predicting Hard Cardiac Events Following Acute Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Girish Dwivedi ◽  
Rajesh Janardhanan ◽  
Sajad A Hayat ◽  
Jonathan A Swinburn ◽  
Roxy Senior
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Death ◽  
Single Photon ◽  
Contrast Echocardiography ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Cardiac Events ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Introduction: The extent of residual myocardial viability (MV) following acute myocardial infarction (AMI) is an important determinant of outcome. 99m technetium sestamibi single photon emission computed tomography (SPECT) is widely used to assess MV following AMI. Hypothesis: We hypothesised that myocardial contrast echocardiography (MCE) which has a better spatial and temporal resolution compared to SPECT will be superior for predicting outcome following AMI. Methods: Accordingly, 99 patients who underwent simultaneous resting low-power MCE & nitrate enhanced SPECT 7 days after AMI were followed up for cardiac death (CD) and AMI. Both SPECT (0=normal;1=mild reduction ;2=moderate reduction;3=severe reduction;4=absent tracer uptake) & MCE perfusion (1=normal;2=reduced;3=absent) were scored on a 16 segment left ventricular (LV) model. Contrast perfusion index (CPI) on MCE and SPECT perfusion index (SPI), both measures of MV, were calculated by adding the respective scores in the 16 LV segments divided by 16. Results: Ninety five patients were available for the follow up (mean 46 months). There were 15 (16%) events (8 CDs & 7 AMIs). Area under the receiver operator characteristic curves for predicting CD and CD or AMI with MCE (0.82 and 0.80 respectively) were higher compared to SPECT (0.76 and 0.74 respectively). Amongst the clinical, biochemical, echocardiographic and SPECT markers of prognosis, only independent predictors of cardiac death and cardiac death or AMI were age and MV determined by MCE (p=0.01 & p=0.002 respectively). Conclusion: MV determined by resting MCE is superior to nitrate enhanced SPECT for the prediction of hard cardiac events following AMI.

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