Page 43 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Brennan 1997
Clinical features and settings Clinical features
• Patients with ESKD at risk of CAD who presented for kidney transplant cardiac
evaluation
Setting
• Washington University and Barnes-Jewish Hospital, St. Louis, Missouri, USA

Participants • Number: 47
• DM: 56%
• Hypertension: 90%
• Sex: 45% male
• Mean age: 51 years
• History of smoking: 61%
• Hypercholesterolaemia: 15%
• Coronary heart failure: 2%
• Clinical evidence CAD: 21%
Study design Cohort study

Target condition and reference standard(s) Coronary artery stenosis measured by coronary angiography
• The criterion for positive test results was ≥ 50% reduction in cross sectional area.

Index and comparator tests DSE
• Two-dimensional echocardiography as part of pretransplant evaluation. Graded
infusions of dobutamine were administered (5 to 40 mg/kg/min) until the maximum
predicted heart rate was achieved. If needed, IV atropine (0.4 to 2.0 mg) was given to
increase heart rate to ~85% of the maximum predicted heart rate. The test was
terminated if patients developed: significant arrhythmia, severe hypertension or
hypotension, or had new or worsening baseline segmental wall motion abnormalities in
≥ 2 major coronary perfusion regions. Segmental wall motion was scored according to
American Society of Echocardiography recommendations, using lh-segment model.
Each segment was graded using a semi-quantitative scoring system (normal or
hyperdynamic (1); hypokinesis (2); akinesis (3); dyskinesis (4)). The wall motion score
index was derived as an average of the 16 segments. All studies were reviewed
independently by 2 experienced echocardiographers who were blinded to the clinical
data.
Follow-up Follow-up (range 3 to 64 months) data were obtained for all 47 participants

Notes Of the 47 patients who underwent DSE, all 5 patients who tested positive received
coronary angiography. Seven other patients who had negative DSE received coronary
angiography. The decision about providing coronary angiography for those who were
index test negative was not made on grounds of clinical or high pre-test suspicion (author
correspondence)

Table of Methodological Quality

Item Authors’ judgement Description

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 41
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.