Page 4 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Main results
The following screening investigations included in the meta-analysis were: dobutamine stress echocardiography (DSE) (13 studies),
myocardial perfusion scintigraphy (MPS) (nine studies), echocardiography (three studies), exercise stress electrocardiography (two
studies), resting electrocardiography (three studies), and one study each of electron beam computed tomography (EBCT), exercise
ventriculography, carotid intimal media thickness (CIMT) and digital subtraction fluorography (DSF). Sufficient studies were present
to allow hierarchical summary receiver operating characteristic (HSROC) analysis for DSE and MPS. When including all available
studies, both DSE and MPS had moderate sensitivity and specificity in detecting coronary artery stenosis in patients who are kidney
transplant candidates [DSE (13 studies) - pooled sensitivity 0.79 (95% CI 0.67 to 0.88), pooled specificity 0.89 (95% CI 0.81 to 0.94);
MPS (nine studies) - pooled sensitivity 0.74 (95% CI 0.54 to 0.87), pooled specificity 0.70 (95% CI 0.51 to 0.84)]. When limiting to
studies which defined coronary artery stenosis using a reference threshold of ≥ 70% stenosis on coronary angiography, there was little
change in these pooled estimates of accuracy [DSE (9 studies) - pooled sensitivity 0.76 (95% CI 0.60 to 0.87), specificity 0.88 (95%
CI 0.78 to 0.94); MPS (7 studies) - pooled sensitivity 0.67 (95% CI 0.48 to 0.82), pooled specificity 0.77 (95% CI 0.61 to 0.88)].
There was evidence that DSE had improved accuracy over MPS (P = 0.02) when all studies were included in the analysis, but this
was not significant when we excluded studies which did not avoid partial verification or use a reference standard threshold of ≥70%
stenosis (P = 0.09).
Authors’ conclusions
DSE may perform better than MPS but additional studies directly comparing these cardiac screening tests are needed. Absence of
significant CAD may not necessarily correlate with cardiac-event free survival following transplantation. Further research should focus
on assessing the ability of functional tests to predict postoperative outcome.

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 2
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.