Published in:
01-02-2017 | Editorial
Cardiovascular risk stratification after renal transplant: Is SPECT-MPI the answer?
Authors:
Karen Kan, MD, Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI
Published in:
Journal of Nuclear Cardiology
|
Issue 1/2017
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Excerpt
Chronic kidney disease (CKD) is highly prevalent and affects close to 1 in 10 adults or over 500 million people worldwide. In recent years, its prevalence has been rapidly increasing due to rises in obesity and its metabolic sequelae—diabetes mellitus.
1 In patients with CKD, cardiovascular disease remains the leading cause of morbidity and mortality, likely due to a combination of traditional cardiovascular risk factors (such as diabetes, hypertension, and hyperlipidemia) and non-traditional risk factors (including inflammation, oxidative stress, and disturbances in mineral bone metabolism).
1 – 5 Although CKD is considered a coronary artery disease (CAD) risk equivalent,
6,
7 with a 15-30 times higher cardiovascular mortality compared to the age-adjusted cardiovascular mortality rate in the general population,
8,
9 our current means of non-invasive risk stratification in this population remains problematic. Conventional cardiac risk factors are less predictive,
10 and the presence of typical symptoms (i.e., chest pain) has poor sensitivity (65%) and specificity (66%) for detecting CAD in CKD patients.
11 As a result, non-invasive stress testing is frequently utilized as a screening modality for the detection of CAD in CKD patients. However, compared to non-CKD cohorts, the accuracy of non-invasive stress testing is also low.
12 …
