Page 45 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Cai 2010
Clinical features and settings Clinical features
• Patients with ESKD and intermediate to high risk of CAD awaiting kidney
transplantation. CAD defined as presence of at least 1 of: age > 50 years, DM, previous
MI or stroke, or extracardiac atherosclerosis
Setting
• Geisinger Medical Center, Danville, Pennsylvania, USA
Participants Patients at intermediate to high risk of CAD underwent DSE 1 to 12 months (median
5 months) before kidney transplantation
• Number: 38
• DM: 54%
• Angina pectoris: percentage not reported
• Hypertension: 86%
• Sex: 64% male

Study design Retrospective cohort study.

Target condition and reference standard(s) Coronary artery stenosis measured by coronary angiography
• The criterion for positive test results was ≥ 70% reduction in cross sectional area.

Index and comparator tests DSE
• Performed according to a standard dobutamine-atropine protocol and included
complete resting echo-Doppler cardiography. Incremental doses of dobutamine (5 to
50 mg/kg/min) infused at 3 minute intervals. If the target (85% predicted maximum
for age) heart rate was not reached, and in the absence of inducible ischaemia, 0.25 mg
IV atropine administered up to a maximum dose of 1 mg. Echocardiographic images
were obtained in the standardised parasternal long- and short-axes (midventricular and
apical), and in apical 2-, 3-, 4-, and 5-chamber views at each stage, and were stored
digitally. DSE end points were defined as development of new or worsening wall
motion abnormality (ischaemia), achievement of > 85% of the predicted maximum
heart rate for age, severe symptoms of angina or dyspnoea, SBP < 85 mm Hg or > 220
mm Hg or a decrease in SBP > 20 mm Hg from one stage to the next, > 2 mV ST
segment depression in at least 2 consecutive leads, or significant arrhythmias (non-
sustained/sustained ventricular/supraventricular tachycardia or high-grade
atrioventricular block).
Follow-up Patients were followed up for a mean of 60 months (range 3 to 145 months) after DSE.
The time from kidney transplant to follow-up was 1 to 135 months (median 49 months)

Notes For the purpose of the analysis, only inducible wall motion abnormalities were counted
as positive DSE

Table of Methodological Quality

Item Authors’ judgement Description

Representative spectrum? Yes Patients with ESKD and intermediate to
All tests high risk of CAD awaiting kidney trans-
plantation

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 43
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.