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They talk about outcomes for patients with End Stage kidney disease and how much better they do after a kidney transplant as opposed to being on dialysis. Their physiologic milieu improves.
They then discuss how exhaustive the cardiac work up is while upholding a stewardship for this limited organ and long waiting list of about 100,000.
The goal is to mitigate the cardiac risk so that the patient and the organ do well post-transplant. Especially reducing the risk for fatal MI.
There are now novel immunomodulators, better medical management and new medications like GLP-1 agonists.
Cardiac phenotypes were discussed including
-pump issues
-valve abnormalites
-Heart failure
-Arrythmias
The most common cause of poor outcomes post transplant is previous hx of MI, heart failure and arrythmias.
Coronary artery testing is covered with stress testing, and cardiac catheterization, angiogram as well as echocardiogram.
We should consider heart failure. Heart failure with preserved ejection fracture is one type as well as pulmonary hypertension.
Atrial fibrillation is the most common arrythmia that exists pre and post transplant. It is important to evaluate the atria on echocardiograms looking for dilation.
Heart failure assesement pre transplant: There are more studies coming by her workgroup. ESKD patients tend to have diastolic heart failure and preserved ejection fraction.
NYHA - New York Heart Association is a functional assessment commonly used to assess patients iwth heart failure.
NYHA at least < 3/4
Optimized clinical symtpoms. No SOB, no leg swelling.
Balancing patient outcomes, frailty and functionality are also very important so as not to limit access to transplantation .
Factors found to place patients at higher risk include:
-Longer Dialysis Vintage
-Long time with DM
-Older age
-Pulmonary HTN
-Multivessel disease
-LAD lesion
-Low ef
-smoking
Pulmonary HTN :Have a multidisciplinary approach include pulmonary and cardiology. ensure their volume is optimized. Early right heart catheterization, An echocardiogram.
ACS(acute coronary syndrome such as unstable angina and a myocardial infarct) vs Stable ischemic heart disease.
The goal being to prevent ACS by doing the pre transplant cardiac testing.
Goal Directed Medical therapy is the gold standard of management.
They conclude by discussing the future of cardiac testing and upcoming trials to discuss the frequency of testing.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.045009
https://www.kumc.edu/mgupta5.html
Please note this is not medical advice. It is meant for entertainment purposes only.
