Accuracy of Myocardial Perfusion Imaging (MPI) in Predicting Post-transplant Cardiovascular Events among Asymptomatic Diabetic Kidney Transplant Candidates

Background: Cardiovascular risk assessment is crucial prior to kidney transplantation especially in diabetic patients as nearly 6.6% of recipients have a major adverse cardiovascular event (MACE) within 3 years. This study aims to evaluate the predictive role of MPI among asymptomatic diabetic candidates for post-kidney transplant cardiovascular events. Methods: This is a retrospective, single center study. We included adult diabetic patients who underwent MPI prior to kidney transplant with a post kidney transplant follow up of 2 years. The primary outcome was a composite of death, ACS, coronary revascularization, hospitalization for heart failure (ADHF), and CVA. These were also studied individually as secondary outcomes. Sensitivity, specificity, PPV and NPV for MPI in detecting obstructive CAD were evaluated in candidates that underwent pre-transplant coronary angiography. Results: Out of 121 candidates, 76 had normal-MPI and 45 had abnormal-MPI. Primary composite outcome was seen in 9 pateints (11.8%) in the normal-MPI group and in 4 (8.9%) in the abnormal-MPI group. More patients in abnormal-MPI group had ADHF (not statistically significant). Out of the 4 normal-MPI patients that had ACS, 3 required post-transplant revascularization, 2 of them did not undergo pre-transplant coronary angiography. In normal-MPI patients, 55 underwent pre-transplant coronary angiography, 8 of them had obstructive CAD. MPI had a sensitivity, specificity, NPV and PPV of 60%, 59.7%, 85% and 27.9% respectively in identifying obstructive CAD as compared to pre-transplant coronary angiography. Conclusion: Diabetic candidates with abnormal-MPI had similar incidence of mortality and MACE post-kidney transplant as compare to normal-MPI patients. MPI had a NPV of 85% in ruling out obstructive CAD. The predictive role of MPI pre kidney transplant remains unclear and needs further study. - Normal-MPI (n=76) Abnormal MPI (n=45) p-value* (n) (%) (n) (%) Primary Composite Outcome 9 11.8 4 8.9 0.765 Death 3 3.9 0 0 0.293 ACS 4 5.2 3 6.7 0.710 Revascularization 3 3.9 0 0 0.293 ADHF 1 1.3 4 8.9 0.063 CVA 1 1.3 0 0 0.628 * Significance of Fisher’s Exact test