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Prognostic value of computed tomography derived fractional flow reserve for predicting cardiac events and mortality in kidney transplant candidates.
- Source :
-
Journal of cardiovascular computed tomography [J Cardiovasc Comput Tomogr] 2022 Sep-Oct; Vol. 16 (5), pp. 442-451. Date of Electronic Publication: 2022 Mar 16. - Publication Year :
- 2022
-
Abstract
- Background: Cardiac screening using coronary computed tomography angiography (CCTA) in kidney transplant candidates before transplantation yields both diagnostic and prognostic information. Whether CT-derived fractional flow reserve (FFR <subscript>CT</subscript> ) analysis provides prognostic information is unknown. This study aimed to assess the prognostic value of FFR <subscript>CT</subscript> for predicting major adverse cardiac events (MACE) and all-cause mortality in kidney transplant candidates.<br />Methods: Among 553 consecutive kidney transplant candidates, 340 CCTA scans (61%) were evaluated with FFR <subscript>CT</subscript> analysis. Patients were categorized into groups based on lowest distal FFR <subscript>CT</subscript> ; normal >0.80, intermediate 0.80-0.76, and low ≤0.75. In patients with ≥50% stenosis, a lesion-specific FFR <subscript>CT</subscript> was defined as; normal >0.80 and abnormal ≤0.80. The primary endpoint was MACE (cardiac death, resuscitated cardiac arrest, myocardial infarction or revascularization). The secondary endpoint was all-cause mortality.<br />Results: Median follow-up was 3.3 years [2.0-5.1]. MACE occurred in 28 patients (8.2%), 29 patients (8.5%) died. When adjusting for risk factors and transplantation during follow-up, MACE occurred more frequently in patients with distal FFR <subscript>CT</subscript> ≤0.75 compared to patients with distal FFR <subscript>CT</subscript> >0.80: Hazard Ratio (HR): 3.8 (95%CI: 1.5-9.7), p < 0.01. In the lesion-specific analysis with <50% stenosis as reference, patients with lesion-specific FFR <subscript>CT</subscript> >0.80 had a HR for MACE of 1.5 (95%CI: 0.4-4.8), p = 0.55 while patients with lesion-specific FFR <subscript>CT</subscript> ≤0.80 had a HR of 6.0 (95%CI: 2.5-14.4), p < 0.01. Abnormal FFR <subscript>CT</subscript> values were not associated with increased mortality.<br />Conclusion: In kidney transplant candidates, abnormal FFR <subscript>CT</subscript> values were associated with increased MACE but not mortality. Use of FFR <subscript>CT</subscript> may improve cardiac evaluation prior to transplantation.<br /> (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Computed Tomography Angiography methods
Constriction, Pathologic
Coronary Angiography methods
Coronary Vessels
Humans
Predictive Value of Tests
Prognosis
Severity of Illness Index
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease therapy
Coronary Stenosis diagnostic imaging
Coronary Stenosis therapy
Fractional Flow Reserve, Myocardial
Kidney Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1876-861X
- Volume :
- 16
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular computed tomography
- Publication Type :
- Academic Journal
- Accession number :
- 35339408
- Full Text :
- https://doi.org/10.1016/j.jcct.2022.03.003