Page 67 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Reis 1995
Clinical features and settings Clinical features
• ESKD patients on dialysis undergoing cardiac evaluation (DSE) as part of
transplant workup. Antihypertensive treatment and aggressive DM control were
undertaken as clinically indicated
Setting
• University of Michigan, Ann Arbor, Michigan, USA

Participants • Number: 97 patients underwent screening; only 30 patients received both DSE
and coronary angiography
• DM: 64%
• Angina pectoris or history of IHD: 30%
• Hypertension: 96%
• Sex: 63% male

Study design Cohort study.

Target condition and reference standard(s) Coronary artery stenosis measured by coronary angiography
• CAD was defined as presence of ≥ 1 coronary arteries with ≥ 50% stenosis.

Index and comparator tests DSE
• After completing a resting echocardiogram, stepwise infusion of dobutamine
starting at 10 pg/kg/min, and increasing to 20 and a peak of 30 or 40 pg/kg/min in 3-
minute stages was initiated.
• All DSE studies were reviewed by experienced echocardiographers blinded to
angiographic data and classified as:
◦ normal response: global increase in contractility, with an associated increase
in ejection fraction, implying an absence of significant obstructive CAD (no regional
wall motion abnormalities were seen at rest or during DSE).
◦ inducible ischaemia: wall motion abnormalities during DSE in 22 segments
in regions that were normal at baseline, implying CAD without prior MI.
◦ fixed response: wall motion abnormality at baseline and no change during
DSE implying prior MI without inducible ischaemia.
◦ mixed response: new and/or worsening wall motion abnormality in a patient
with a wall motion abnormality at rest, implying prior MI with additional inducible
ischaemia.
Follow-up 12 ± 6 months.

Notes

Table of Methodological Quality

Item Authors’ judgement Description

Representative spectrum? Yes ESKD patients undergoing cardiac evalua-
All tests tion as part of transplant workup

Acceptable reference standard? Yes Coronary angiography with a reference
All tests standard threshold of ≥ 50% stenosis

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 65
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.