Diagnostic and prognostic role of myocardial perfusion scintigraphy in kidney transplant candidates : narrative review

Purpose: Cardiac screening in adult kidney transplant candidates with myocardial perfusion scintigraphy (MPS) can reveal findings associated with increased risk for coronary heart disease events, but the exact value of this screening test is still undetermined. Methods: Narrative review based on the available literature and guidelines on the yield, benefits, and harms of MPS screening in kidney transplant candidates. Results: Although coronary angiography carries low risk in general population, it is not without risk particularly in patients with complex comorbid disease and the use of intravenous contrast media may precipitate a need for hospitalization and death. We could avoid invasive coronary angiography in patients with chronic kidney disease, although with high coronary calcium score, but good left ventricle function and normal perfusion, evaluated by Gated single-photon emission computed tomographic (SPECT) MPS. In fact, although Gated SPECT MPS has not a high sensitivity, it provides some variables that are closely related to sudden death: post-stress and rest-ejection fraction and left ventricular volumes, left ventricle muscle mass, extent of ischemia and scar. Conclusions: Gated SPECT MPS is a valid noninvasive cardiac screening test. It can be used as alternative to stress echocardiography in kidney transplant candidates with high cardiovascular risk and a positive or inconclusive exercise tolerance ECG test. Patients with abnormal perfusion and cardiac dysfunction should undergo invasive coronary artery imaging and endovascular treatment, while angiography could be avoided in patients with normal MPI, having good long-term prognosis.