External Validation of Proposed American Heart Association Algorithm for Cardiovascular Screening Before Kidney Transplantation

作者：Marie Bodilsen Nielsen, Jonathan Nørtoft Dahl, Bente Jespersen, Per Ivarsen, Henrik Birn, Simon Winther · 发表于：Journal of the American Heart Association · 年份：2023 · DOI：10.1161/jaha.123.031150 · 被引用次数：3 · 研究领域：Renal and Vascular Pathologies、Cardiac Imaging and Diagnostics、Organ Transplantation Techniques and Outcomes

Background Screening for cardiovascular disease is currently recommended before kidney transplantation. The present study aimed to validate the proposed algorithm by the American Heart Association (AHA‐2022) considering cardiovascular findings and outcomes in kidney transplant candidates, and to compare AHA‐2022 with the previous recommendation (AHA‐2012). Methods and Results We applied the 2 screening algorithms to an observational cohort of kidney transplant candidates (n=529) who were already extensively screened for coronary heart disease by referral to cardiac computed tomography between 2014 and 2019. The cohort was divided into 3 groups as per the AHA‐2022 algorithm, or into 2 groups as per AHA‐2012. Outcomes were degree of coronary heart disease, revascularization rate following screening, major adverse cardiovascular events, and all‐cause death. Using the AHA‐2022 algorithm, 69 (13%) patients were recommended for cardiology referral, 315 (60%) for cardiac screening, and 145 (27%) no further screening. More patients were recommended cardiology referral or screening compared with the AHA‐2012 (73% versus 53%; P <0.0001). Patients recommended cardiology referral or cardiac screening had a higher risk of major adverse cardiovascular events (hazard ratio [HR], 5.5 [95% CI, 2.8–10.8]; and HR, 2.1 [95% CI, 1.2–3.9]) and all‐cause death (HR, 12.0 [95% [CI, 4.6–31.4]; and HR, 5.3 [95% CI, 2.1–13.3]) compared with patients recommended no further screening, and were more oft...