Funding Acknowledgements Type of funding sources: None. Background A high prevalence of asymptomatic coronary artery disease (CAD) is found in patients with end-stage renal disease evaluated for kidney transplantation. Purpose We aimed to assess the diagnostic accuracy of myocardial perfusion imaging (MPI) for CAD in this patients population. Methods We performed a systematic literature search and meta-analysis. We retrieved studies investigating the diagnostic accuracy of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) compared to the standards invasive coronary angiography (ICA) and coronary computed tomography angiography (CCTA) in patients evaluated for kidney transplantation. Results Out of 1379 records, 9 MPI SPECT studies were included in the meta-analysis with a total of 822 patients. There were no studies available using PET with ICA or CCTA as reference. Pooled sensitivity of MPI SPECT for CAD was 0.66 (95%-CI 0.52-0.78), pooled specificity 0.72 (95%-CI 0.57-84) and the area under the curve (AUC) 0.74. Positive likelihood ratio (PLR) was 2.31 (95%-CI 1.57-3.39) and negative likelihood ratio (NLR) was 0.41 (95%-CI 0.25-0.68) with an overall diagnostic odds ratio (DOR) of 5.43 (95%-CI 2.87-10.28). Significant heterogeneity existed across included studies. Conclusions MPI SPECT had a moderate diagnostic accuracy in patients evaluated for kidney transplantation, with a high rate of false-negative findings.
Funding Acknowledgements Type of funding sources: None. Background Kidney transplant recipients are at risk for major adverse cardiac events (MACE) and cardiovascular mortality. We aimed to assess the prognostic value of myocardial perfusion imaging (MPI) single-photon emission computed tomography (SPECT), in patients evaluated for transplantation, for MACE and cardiovascular mortality after kidney transplantation. Methods We performed a systematic literature search in PubMed, EMBASE, Web of Science, OvidSP, The Cochrane Library and Google Scholar. We retrieved studies investigating the prognostic value of MPI for MACE and mortality in kidney transplant recipients. After risk of bias assessment using QUIPS, a meta-analysis was conducted. Results Out of 1379 records, 14 studies (7 prospective and 7 retrospective) using MPI SPECT were included in the meta-analysis with a total of 4643 MPI procedures. No studies were excluded after QUIPS assessment. Median follow-up duration of patients ranged from 1 to 8 years. Kidney transplant recipients with perfusion defects on MPI showed an increased risk for MACE (RR 2.76, 95%-CI 1.73-4.42), cardiovascular mortality (RR 3.15, 95%-CI 1.94-5.13) and all-cause mortality (RR 2.12, 95%-CI 1.76-2.54) compared to recipients with normal MPI findings. Significant heterogeneity existed across the included studies investigating MACE. Conclusions Our results showed that MPI SPECT may identify patients at increased risk for MACE and mortality after kidney transplantation.
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