Author + information
- Received September 15, 2014
- Revision received November 26, 2014
- Accepted December 4, 2014
- Published online May 1, 2015.
- Simon Winther, MD∗∗ (, )
- My Svensson, MD, PhD†,
- Hanne Skou Jørgensen, MD†,
- Kirsten Bouchelouche, MD, DMSc‡,
- Lars Christian Gormsen, MD, PhD‡,
- Birgitte Bang Pedersen, MD, PhD§,
- Niels Ramsing Holm, MD∗,
- Hans Erik Bøtker, MD, DMSc∗,
- Per Ivarsen, MD, PhD† and
- Morten Bøttcher, MD, PhD‖
- ∗Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- †Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark
- ‡Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Denmark
- §Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
- ‖Department of Internal Medicine, Hospital Unit West, Herning, Denmark
- ↵∗Reprint requests and correspondence:
Dr. Simon Winther, Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, DK-8200 Aarhus, Denmark.
Objectives The goal of this study was to compare the diagnostic accuracy of the coronary artery calcium score (CACS), coronary computed tomography angiography (CTA), single-photon emission computed tomography (SPECT), and a combination of these tools in the diagnosis of obstructive coronary artery disease (CAD) in patients with chronic kidney disease referred for cardiac evaluation before kidney transplantation.
Background The optimal method for the detection of obstructive CAD in potential kidney transplant patients has not yet been identified. Previous studies have found that established noninvasive stress tests have low diagnostic accuracy, while the diagnostic performance of coronary CTA remains unknown.
Methods We prospectively studied 138 patients referred for pre-transplant cardiac evaluation (mean age 54 years; age range 22 to 72 years; 68% male; 43% treated with dialysis). All patients underwent CACS, coronary CTA, SPECT, and invasive coronary angiography. The results of the noninvasive tests were merged into integrated hybrid imaging results: Hybrid (CACS/SPECT) and Hybrid (coronary CTA/SPECT).
Results The overall prevalence of obstructive CAD (≥50% reduction in luminal diameter) according to quantitative invasive coronary angiography was 22%. Two-thirds of the patients with obstructive CAD had a stenosis located in a proximal coronary segment. In a patient-level model, the sensitivity and specificity, respectively, for diagnosing obstructive CAD were as follows: CACS (threshold of 400), 67% and 77%; coronary CTA, 93% and 63%; SPECT, 53% and 82%; Hybrid (CACS/SPECT), 33% and 97%; and Hybrid (coronary CTA/SPECT), 67% and 86%. The sensitivity for diagnosing obstructive CAD in a proximal segment was 70% for CACS (threshold 400), 100% for coronary CTA, 60% for SPECT, 40% for Hybrid (CACS/SPECT), and 75% for Hybrid (coronary CTA/SPECT).
Conclusions Coronary CTA is a reliable test with high sensitivity and a high negative predictive value for diagnosing obstructive CAD before kidney transplantation. A noninvasive approach with use of either coronary CTA or a combination of coronary CTA and SPECT to rule out obstructive CAD seems recommendable in kidney transplant candidates. (ACToR-Study: Angiographic CT of Renal Transplantation Candidate–Study; NCT01344434)
- coronary angiography
- coronary computed tomography angiography
- renal transplantation
- sensitivity and specificity
- single-photon emission computed tomography
This study was supported by the Karen Elise Jensen Foundation, the Bjørnows Foundation, the Danish Society of Nephrology Research Foundation, and the Health Research Fund of Central Denmark Region. Dr. Holm has received research grants from Terumo, St. Jude Medical, Boston Scientific, Medtronic, Tryton Medical, Alvimedica, and Biotronik; and speaker fees from Terumo, St. Jude Medical, and Biotronik. Dr. Bøtker has been a shareholder in CellAegis Devices Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 15, 2014.
- Revision received November 26, 2014.
- Accepted December 4, 2014.
- 2015 American College of Cardiology Foundation