Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study
Background: Cardiac evaluation before deceased donor kidney transplant (DDKT) remains a matter of debate. Data on Asian countries and countries with prolonged waiting times are lacking. This study aimed to assess the outcomes of patients referred for DDKT after a cardiac evaluation at an Asian terti...
| Main Authors: | , , , , , , , , , , , |
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| Other Authors: | |
| Format: | Journal Article |
| Language: | English |
| Published: |
2023
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| Online Access: | https://hdl.handle.net/10356/164586 |
| _version_ | 1811689617082023936 |
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| author | Vijayan, Swati Ho, Quan Yao Koh, Choong Hou Liew, Ian Tatt Thangaraju, Sobhana Wong, Ningyan Keh, Yann Shan Ong, Sharel Zi Hui Tan, Jia Qin Yeo, Khung Keong Chua, Terrance Siang Jin Kee, Terence |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Vijayan, Swati Ho, Quan Yao Koh, Choong Hou Liew, Ian Tatt Thangaraju, Sobhana Wong, Ningyan Keh, Yann Shan Ong, Sharel Zi Hui Tan, Jia Qin Yeo, Khung Keong Chua, Terrance Siang Jin Kee, Terence |
| author_sort | Vijayan, Swati |
| collection | NTU |
| description | Background: Cardiac evaluation before deceased donor kidney transplant (DDKT) remains a matter of debate. Data on Asian countries and countries with prolonged waiting times are lacking. This study aimed to assess the outcomes of patients referred for DDKT after a cardiac evaluation at an Asian tertiary transplant center. Methods: This single-center retrospective review analyzed patients who were referred for waitlist placement and underwent cardiac stress testing between January 2009 and December 2015. Patients with cardiac symptoms were excluded. The primary outcome was three-point major adverse cardiovascular events (MACE), a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. Results: Of 468 patients referred for DDKT, 198 who underwent cardiac stress testing (myocardial perfusion studies in 159 patients and stress echocardiography in 39 patients) were analyzed. MACE occurred in 20.7% of the patients over a median follow-up of 4.6 years. Cardiac stress tests were positive for ischemia in 19.7% of the patients. Coronary angiography was performed in 63 patients, including 29 patients with diabetic kidney disease and negative cardiac stress tests. Significant coronary artery disease (CAD) was detected in 27 patients (42.8%), of whom 18 underwent revascularization. MACE was associated with significant CAD on coronary angiography in the multivariable analysis. Cardiac stress test results were not associated with MACE. Amongst diabetic patients who had negative cardiac stress tests, 37.9% had significant CAD on coronary angiography. Conclusions: The cardiovascular disease burden is significant amongst DDKT waitlist candidates. Pretransplant cardiac screening may identify patients with significant CAD at higher risk of MACE. |
| first_indexed | 2024-10-01T05:50:57Z |
| format | Journal Article |
| id | ntu-10356/164586 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T05:50:57Z |
| publishDate | 2023 |
| record_format | dspace |
| spelling | ntu-10356/1645862023-03-05T16:54:29Z Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study Vijayan, Swati Ho, Quan Yao Koh, Choong Hou Liew, Ian Tatt Thangaraju, Sobhana Wong, Ningyan Keh, Yann Shan Ong, Sharel Zi Hui Tan, Jia Qin Yeo, Khung Keong Chua, Terrance Siang Jin Kee, Terence Lee Kong Chian School of Medicine (LKCMedicine) Science::Medicine Kidney Transplantation Cardiovascular Diseases Background: Cardiac evaluation before deceased donor kidney transplant (DDKT) remains a matter of debate. Data on Asian countries and countries with prolonged waiting times are lacking. This study aimed to assess the outcomes of patients referred for DDKT after a cardiac evaluation at an Asian tertiary transplant center. Methods: This single-center retrospective review analyzed patients who were referred for waitlist placement and underwent cardiac stress testing between January 2009 and December 2015. Patients with cardiac symptoms were excluded. The primary outcome was three-point major adverse cardiovascular events (MACE), a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death. Results: Of 468 patients referred for DDKT, 198 who underwent cardiac stress testing (myocardial perfusion studies in 159 patients and stress echocardiography in 39 patients) were analyzed. MACE occurred in 20.7% of the patients over a median follow-up of 4.6 years. Cardiac stress tests were positive for ischemia in 19.7% of the patients. Coronary angiography was performed in 63 patients, including 29 patients with diabetic kidney disease and negative cardiac stress tests. Significant coronary artery disease (CAD) was detected in 27 patients (42.8%), of whom 18 underwent revascularization. MACE was associated with significant CAD on coronary angiography in the multivariable analysis. Cardiac stress test results were not associated with MACE. Amongst diabetic patients who had negative cardiac stress tests, 37.9% had significant CAD on coronary angiography. Conclusions: The cardiovascular disease burden is significant amongst DDKT waitlist candidates. Pretransplant cardiac screening may identify patients with significant CAD at higher risk of MACE. Published version 2023-02-06T02:17:43Z 2023-02-06T02:17:43Z 2022 Journal Article Vijayan, S., Ho, Q. Y., Koh, C. H., Liew, I. T., Thangaraju, S., Wong, N., Keh, Y. S., Ong, S. Z. H., Tan, J. Q., Yeo, K. K., Chua, T. S. J. & Kee, T. (2022). Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study. Korean Journal of Transplantation, 36(3), 187-196. https://dx.doi.org/10.4285/kjt.22.0029 2671-8790 https://hdl.handle.net/10356/164586 10.4285/kjt.22.0029 36275988 2-s2.0-85141958494 3 36 187 196 en Korean Journal of Transplantation © The Korean Society for Transplantation This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. application/pdf |
| spellingShingle | Science::Medicine Kidney Transplantation Cardiovascular Diseases Vijayan, Swati Ho, Quan Yao Koh, Choong Hou Liew, Ian Tatt Thangaraju, Sobhana Wong, Ningyan Keh, Yann Shan Ong, Sharel Zi Hui Tan, Jia Qin Yeo, Khung Keong Chua, Terrance Siang Jin Kee, Terence Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study |
| title | Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study |
| title_full | Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study |
| title_fullStr | Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study |
| title_full_unstemmed | Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study |
| title_short | Cardiac evaluation for end-stage kidney disease patients on the transplant waitlist: a single-center cohort study |
| title_sort | cardiac evaluation for end stage kidney disease patients on the transplant waitlist a single center cohort study |
| topic | Science::Medicine Kidney Transplantation Cardiovascular Diseases |
| url | https://hdl.handle.net/10356/164586 |
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