Page 76 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

P. 76

Vandenberg 1996

Clinical features and settings Clinical features
• Patients with kidney disease and DM referred for kidney and/or pancreas
transplantation from 1988 to 1993 undergoing cardiac evaluation as part of transplant
workup with no history of angina, MI, coronary artery bypass surgery, or percutaneous
transluminal coronary angioplasty; pharmacologic stress thallium scintigraphy and/or
exercise radionuclide ventriculography performed as part of the evaluation; and
coronary artery angiography performed within 6 months after the radionuclide
evaluation (and no cardiac symptoms in the interim period).
Setting
• Cardiovascular Center, University of Iowa College of Medicine, Iowa, USA

Participants • Number: 47
• DM: 100%
• Angina pectoris or IHD: Nil
• Hypertension: 74%. 35/74 (74%)
◦ Patients were taking antihypertensive medications, including beta blockers
and calcium channel blockers; medications were continued during stress testing
• Sex: not reported

Study design Cohort study

Target condition and reference standard(s) Coronary artery stenosis measured by coronary angiography
• CAD deﬁned as presence of ≥ 1 coronary arteries with ≥ 75% diameter stenosis.
Separate data available for 50% stenosis

Index and comparator tests Pharmacologic stress thallium scintigraphy
• IV dipyridamole was infused at a rate of 0.142 mg/kg per min for 4 min. IV
adenosine was infused at a rate of 0.14 mg/kg per min for 6 min. Thallium-201 (3
mCi) was injected IV 5 min after the completion of the dipyridamole infusion or 4
min after the beginning of the adenosine infusion. Imaging was performed within 10
min with a gamma-camera. Planar images in anterior and lateral projections were
obtained and were followed immediately by single-photon emission CT imaging.
Images were interpreted by consensus of two experienced radiologists who were
unaware of the angiography results. Test results were considered abnormal if either a
ﬁxed or a reversible defect was present.
Exercise radionuclide ventriculography
• Radionuclide ventriculography was performed in 40 patients using a modiﬁed in
vivo red blood cell-labelling technique with an initial IV injection of 5.1 mg of
stannous pyrophosphate, followed by 25 to 30 mCi of technetium-99m pertechnetate.
Patients performed semi supine exercise with a bicycle ergometer table during
continuous 12-lead ECG monitoring. Exercise was begun at a pedal speed of 50 rpm
and a work load of about 50 watts, which was increased by 10 watts every 30 sec to a
symptom-limited maximum. Heart rate and blood pressure were recorded at each
exercise level. Images were obtained in the left anterior oblique projection at peak
exercise and ejection fraction was calculated from this image. Exercise was considered
adequate if the peak rate pressure product was > 20,000 or if the rate pressure product
at least doubled from baseline to peak exercise.
• A test result was considered abnormal if any of the following were present:
◦ resting ejection fraction of < 50%

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