MedStar Researchers Investigate Cardiovascular Testing

Researchers from MedStar Heart & Vascular Institute, MedStar Washington Hospital Center, MedStar Georgetown University Hospital and National Institute of Health have recently sought to identify pre-transplantation cardiac testing practices and to report post-transplant cardiac outcomes in patients receiving renal allografts.

“Pre-Operative Cardiovascular Testing and Post-Renal Transplant Clinical Outcomes” was published in Cardiovascular Revascularization Medicine. Chronic kidney disease and end-stage renal disease are closely linked to coronary artery disease. This retrospective analysis examined demographics and medical data for patients undergoing first renal transportation. Pre-transplant workup included echocardiograms, cardiac stress testing, coronary computed tomography, left heart catherization and any revascularization.

The research included 235 patients and the mean length of follow-up was 1.63 years. Patients were reviewed for use of antiplatelet, HMG-CoA reductase inhibitors (statins), insulin, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, mineralocorticoid receptor antagonists, and diuretics over a 6-month period before transplant. 219 (93%) patients had non-invasive functional testing before transplant. The most common co-morbidity was hypertension (88.1%), and the most common pre-transplant medication class was beta blockers (59.6%). The most common cause of chronic kidney disease/end-stage renal disease was hypertension (36.7%) and diabetes mellitus (26.2%). There were 3 deaths, 2 that were cardiac-specific. Of those patients with a 30-day post-operative troponin, 30 (13%) patients had an elevation due to a type II NSTEMI or myocardial injury.

The results of the study show that cardiovascular testing remains an ever-present practice in pre-transplant evaluation, with an ongoing low rate of adverse cardiac outcomes for those patients who are ultimately deemed suitable for kidney transplant. In conclusion, this study demonstrates low mortality despite the relative frequency of post-operative troponin elevation. “There is no clear pattern of pre-cardiac testing results or revascularization inpatients who develop post-transplant major adverse cardiac outcomes.”

The research team included Michael Yang, Patrick Miller, PT, DPT; Brian C. Case, MD; Alexander J. Gilbert, MD; Jared K. Widell, MD; Toby Rogers, MD; Lowell F. Satler, MD; Ron Waksman, MD; and Itsik Ben-Dor, MD.

Cardiovascular Revascularization Medicine, 2019. DOI: 10.1016/j.carrev.2019.04.017