Page 57 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Gowdak 2010 (Continued)

Withdrawals explained? Yes No withdrawals reported.
All tests

Herzog 1999

Clinical features and settings Clinical features
Patients referred for kidney transplantation evaluation from June 1992 to January 1995
• ESKD from diabetic kidney disease or other causes
• unable to perform treadmill exercise
• ≥ 2 CAD risk factors: male; HTN; hypercholesterolaemia (total cholesterol level
240 mg/dL or low-density lipoprotein cholesterol level 160 mg/dL); history of
smoking; family history or any evidence suggestive of IHD (angina, effort dyspnoea,
previous MI by history or ECG, or abnormal global or regional left ventricular
function)
Setting
• Hennepin County Medical Center, Minneapolis, Minnesota, USA

Participants • Patients were predominantly middle-aged white men. Nearly all patients (92%)
were undergoing chronic haemodialysis
• Number: 50
• DM: 82%
• Angina pectoris: 16%
• Hypertension: 94%
• Sex: 60% male
Exclusion criteria
• Significant aortic stenosis; unstable angina; inability to obtain informed consent;
previous coronary angiography

Study design Cohort study

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

Index and comparator tests DSE
• End points for stopping drug infusion were: new inducible wall motion
abnormalities involving ≥ 2 coronary artery vascular territories, intolerable patient
discomfort, angina with ≥ 2 mm ST segment depression or elevation in a previously
normal ECG lead, significant tachyarrhythmia (sustained supraventricular tachycardia
or ≥ 3-beat run of ventricular tachycardia), symptomatic severe hypotension, SBP ≥
240 mm Hg or DBP ≥ 120 mm Hg, attaining target heart rate ([220 - age] × 0.85), or
reaching the maximum dose of dobutamine and atropine.
• DSE studies were analysed in digital format independently by three
echocardiographers blinded to angiographic data. DSE study was defined as positive
for inducible ischaemia when ≥ 1 normal segments developed absolute or relative
hypokinesis with stress compared with other segments or an abnormal segment at rest
had deterioration of regional systolic thickening with stress. DSE study result was
normal if all segments were hyperdynamic with stress. If a resting baseline regional wall

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 55
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.