Page 80 - Cardiac testing for coronary artery disease in potential kidney transplant recipients

Worthley 2003

Clinical features and settings Clinical features
• ESKD patients with multiple risk factors (> 60 years; HTN; DM; history of
smoking; family history of CAD; hypercholesterolaemia) undergoing cardiac
evaluation as part of transplant workup
Setting
• North Western Adelaide Health Service, University of Adelaide, Australia

Participants • Number: 40
• DM: 78%
• Angina pectoris or IHD: 18%
• Hypertension: 98%
• Sex: 48% male
Exclusion criteria
• Normal coronary angiography within the preceding 2 years; coronary
revascularisation within the last 12 months; evidence of previous Q-wave infarction on
ECG at rest; class III to IV angina pectoris at study entry

Study design Cohort study

Target condition and reference standard(s) Coronary artery stenosis measured by coronary angiography
• Angiograms were assessed by 2 cardiologists who were blinded to the perfusion
imaging results. A significant coronary stenosis was defined as > 70%

Index and comparator tests Tachycardic-stress perfusion imaging
• All patients underwent induction of tachycardiac stress via treadmill exercise or
temporary cardiac pacing. Treadmill exercise was performed using the Bruce protocol,
on a symptom-limited basis. Exercise was deemed adequate if peak heart rate was >
75% of the theoretic maximal values, or if exercise was terminated because of angina
pectoris. Pacing was performed in patients unable to attain adequate stress on treadmill
testing. Pacing was performed at the time of cardiac catheterisation, but before
coronary angiography. Myocardial imaging was achieved by IV injection of
technetium-99m tetrofosmin (400 MBq) 1 minute before termination of tachycardiac
stress. Images were acquired on a triple-headed gamma camera with 180° single-
photon emission CT. The images were assessed by nuclear cardiologists who were
blinded to the cardiac catheterisation results.

Follow-up Mean follow-up of 28 ± 10 months.

Notes Informed consent was obtained before study entry.

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 ≥ 70% stenosis

Cardiac testing for coronary artery disease in potential kidney transplant recipients (Review) 78
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.