Multimodality Tachycardia-induced Stress Testing Predicts a Low Risk Group for Early Cardiovascular Mortality After Renal Transplantation

Abstract Background Cardiovascular events remain a major cause of death in kidney transplant recipients. The optimal non-invasive work-up to prevent peri-transplant cardiac mortality remains contentious. Methods We conducted a retrospective analysis to assess the renal transplantation cardiovascular assessment protocol within a single-centre population over a 5-year period. Asymptomatic patients under 45-years, with no history of cigarette smoking, without diabetes mellitus, and dialysis-dependent for less than 24-months, did not undergo cardiac testing prior to listing. All other asymptomatic patients underwent a non-invasive, tachycardia-induced stress test, where a target heart rate of 85% predicted for age and gender was required. The primary endpoints were rates of acute myocardial infarction (AMI) and cardiovascular death at 30-days after renal transplantation. Results Between 2015 and 2019, a total of 380 recipients underwent cardiac evaluation: 79 (20.8%) were deemed low cardiovascular risk and placed on the renal transplant waitlist without further assessment; 270 (71.1%) underwent a tachycardia-induced stress test; and 31 (8.1%) were deemed high risk and proceeded directly to invasive coronary angiography (ICA). In the five-year follow-up, three patients (0.8%) experienced an AMI at 30-days after renal transplantation, all of which occurred in the high risk ‘direct to ICA’ cohort. No events were documented in the low-risk cohort or in patients that had a negative tachycardia-induced stress test. There were no cardiovascular deaths within 30 days after transplantation. Conclusion A negative tachycardia-induced cardiac stress test, achieving 85% predicted heart rate, was associated with a 0% AMI rate and no cardiovascular deaths at 30-days after renal transplantation.