Cardiac imaging for the assessment of patients being evaluated for kidney or liver transplantation

Abstract

Cardiac risk assessment prior to kidney and liver transplantation is controversial. Given the paucity of available organs, selecting appropriate recipients with favorable short- and long-term cardiovascular risk profile is crucial. Using noninvasive cardiac imaging tools to guide cardiovascular risk assessment and management can also be challenging and controversial. In this article, we address the burden of coronary artery disease among kidney and liver transplant candidates and review the literature pertaining to the diagnostic accuracy and the prognostic value of noninvasive cardiac imaging techniques in this population.

Screening for Coronary Artery Disease in Kidney Transplant Candidates

“…6 The evaluation of this high risk population in preparation for transplantation is different from that advocated by the American College of Cardiology (ACC)/American Heart Association (AHA) Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Non-cardiac Surgery. 7 In this issue of the Journal, Parikh et al 8 review the Scientific Statement From the AHA and the ACC for the Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates 9 and highlight the challenges faced during the evaluation of these patients. We will focus our editorial on the kidney transplantation part of the Statement.…”

“…9 The Statement then acknowledges that ''there are no definitive data at this time for or against screening for myocardial ischemia among kidney transplantation candidates who are free of active cardiac conditions.'' Parikh et al, 8 state the case clearly and effectively against invasive or noninvasive coronary angiography as screening tool for coronary artery disease (CAD) in all transplant candidates. They summarize the diagnostic accuracy of noninvasive stress testing using myocardial perfusion imaging and stress echocardiography ( Table 1 in 8 ) and indicate that it is comparable for both imaging modalities.…”

“…Parikh et al, 8 state the case clearly and effectively against invasive or noninvasive coronary angiography as screening tool for coronary artery disease (CAD) in all transplant candidates. They summarize the diagnostic accuracy of noninvasive stress testing using myocardial perfusion imaging and stress echocardiography ( Table 1 in 8 ) and indicate that it is comparable for both imaging modalities. They also describe the prognostic data available for both tests ( Table 2 in 8 ) and conclude that ''the choice of testing modality should be based upon the expertise of the particular transplant center.''…”

“…They summarize the diagnostic accuracy of noninvasive stress testing using myocardial perfusion imaging and stress echocardiography ( Table 1 in 8 ) and indicate that it is comparable for both imaging modalities. They also describe the prognostic data available for both tests ( Table 2 in 8 ) and conclude that ''the choice of testing modality should be based upon the expertise of the particular transplant center.'' Therefore, the use of these noninvasive stress tests to select patients for coronary angiography seems to be a reasonable approach when applied to the appropriate populations.…”

“…Further, the specific number of these risk factors that should trigger testing is not well defined, as clearly stated by the Writing Committee which suggested three or more risk factors as a reasonable starting point. 9 An important consideration not addressed in the AHA/ACC Statement 9 or in the review-by Parikh et al 8 is the risk of contrast nephropathy associated with coronary angiography in this population.…”