Work

Prognostic value of computed tomography derived fractional flow reserve for predicting cardiac events and mortality in kidney transplant candidates

Year: 2022

Type: article

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 CT ) analysis provides prognostic information is unknown. This study aimed to assess the prognostic value of FFR CT for predicting major adverse cardiac events (MACE) and all-cause mortality in kidney transplant candidates. Methods Among 553 consecutive kidney transplant candidates, 340 CCTA scans (61%) were evaluated with FFR CT analysis. Patients were categorized into groups based on lowest distal FFR CT ; normal >0.80, intermediate 0.80–0.76, and low ≤0.75. In patients with ≥50% stenosis, a lesion-specific FFR CT 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. 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 CT ≤0.75 compared to patients with distal FFR CT >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 CT >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 CT ≤0.80 had a HR of 6.0 (95%CI: 2.5–14.4), p < 0.01. Abnormal FFR CT values were not associated with increased mortality. Conclusion In kidney transplant candidates, abnormal FFR CT values were associated with increased MACE but not mortality. Use of FFR CT may improve cardiac evaluation prior to transplantation.

Source: Journal of cardiovascular computed tomography

DOI: 10.1016/j.jcct.2022.03.003