Page 47 - Cardiac testing for coronary artery disease in potential kidney transplant recipients
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De Lima 2003  (Continued)


                                                  • Sex: 77% male

                 Study design                   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.
                                                Invasive and non-invasive testing were analysed independently by 2 experts in the
                                                respective methods without previous knowledge of the experimental hypothesis.
                                                Disagreement was arbitrated by a third expert.


                 Index and comparator tests     DSE
                                                  • Stepwise infusion of dobutamine was started at 5 µg/kg/min and increased to 40
                                                µg/kg/min in 3 minute stages. Inducible ischaemia was defined as hypokinesis or as
                                                accentuation of the degree of baseline hypokinesis during the infusion. The test was
                                                interrupted if SBP or DBP surpassed 220 mm Hg and 120 mm Hg, respectively, or
                                                when SBP fell below 90 mm Hg.
                                                  • Dipyridamole stress testing (single photon emission-computed tomography with
                                                technecium-99m methoxyisobutylisonitrite)
                                                     ◦ Stress was induced by dipyridamole (0.5 mg/kg IV). Fixed perfusion defects
                                                were interpreted as evidence of fibrosis; transient hypoperfusion was interpreted as
                                                ischaemia.

                 Follow-up                      Five participants were lost to follow-up. Minimum and mean follow-up periods were
                                                6 and 26 months, respectively. The outcome measure was cardiac events, predefined
                                                as sudden death, MI, life-threatening arrhythmia, heart failure, pulmonary oedema,
                                                unstable angina, and myocardial revascularisation

                 Notes

                 Table of Methodological Quality

                 Item                           Authors’ judgement             Description

                 Representative spectrum?       Yes                            Kidney transplantation candidates as part
                 All tests                                                     of cardiac evaluation

                 Acceptable reference standard?  Yes                           Coronary angiography with a reference
                 All tests                                                     standard threshold of ≥ 70% stenosis

                 Acceptable delay between tests?  Yes                          Interval between tests was 2 to 6 weeks (au-
                 All tests                                                     thor correspondence)

                 Partial verification avoided?   Yes                            All participants who underwent an index
                 All tests                                                     test also received the reference standard test

                 Differential verification avoided?  Yes                        Disease status (CAD) diagnosed by coro-
                 All tests                                                     nary angiography.





                Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review)  45
                Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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