Page 51 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Gang 2007 (Continued)

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

Index and comparator tests DSE
• DSE was performed by recording images in standard parasternal long- and short-
axis and apical 4 chamber and 2 chamber views at baseline, and during stepwise
infusion of dobutamine in 3 minute stages at 5, 10, 20, 30 and 40 µg/kg/min.
Atropine was administered as needed. DSE end points were target heart rate achieved
([220-age]x0.85), maximum drug dose, intolerable angina, new inducible regional wall
motion abnormalities in ≥ 2 coronary vascular territories, ventricular tachycardia,
supraventricular tachycardia, hypotension and SBP > 240 mm Hg.
Resting ECG
• Abnormal ECG findings included evidence of left ventricular hypertrophy by
voltage criteria (8 patients), evidence of underlying ischaemia, or left bundle branch
block.

Follow-up None

Notes • Patients underwent DSE followed by coronary angiography as a part of kidney
transplant evaluation.
• Resting ECG was discounted from the analysis as “abnormal ECG”. This was a
heterogeneous concept that was suggestive of both ischaemic and non-ischaemic (such
as left ventricular hypertrophy) results. 12/40 patients (30%) had baseline ECG
evidence of left ventricular hypertrophy by voltage criteria, 8 (20%) patients had
evidence of underlying ischaemia; one patient (4%) had left bundle branch block. 19
patients had normal ECGs. 9/21 patients whose ECGs were abnormal had significant
CAD on angiography.

Table of Methodological Quality

Item Authors’ judgement Description

Representative spectrum? Yes Patients with DM and ESKD who pre-
All tests sented for kidney transplant cardiac evalu-
ation

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

Acceptable delay between tests? Yes DSE and coronary angiography were per-
All tests formed within the same week (author cor-
respondence)

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) 49
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.