[Use of stress echocardiography in detecting silent myocardial ischemia in hemodialysis patients].
The chronic renal failure treated by hemodialysis is associated with a high incidence of prematured cardiovascular diseases, which represents the major causes of morbidity and mortality in hemodialysis patients.


OBJECTIVE
To evaluate the interest of stress echocardiography for the detection of silent myocardial ischaemia in the chronic renal failure treated by hemodialysis.


METHODS
24 dobutamine stress echocardiography have been achieved in to patients having an average old of 61 +/- 11 years, 15 men and 3 women, with an average dialysis duration of 55 +/- 27 months. Only asymptomatic patients and those presenting an anomaly during the systematic annual echocardiography supervision have been included in this retrospective work. All echocardiography enregistrements have been achieved in the same center and by the same and experimented cardiologist.


RESULTS
75% of patients had an arterial hypertension antecedents, 65% were smokers, 50% had a dyslipidemia, 38% presented an arteriopathy of the inferior members, 30% had diabetes and 22% were obese; 8 (33.5%) stress echocardiographies were negatives. 6 patients have had 2 stress echocardiographies. A coronarography was realized in 16 patients and one of those was strictly normal (6.25% were false positive). 8 patients have had an angioplasty with stent making (1 simple stent, 7 double stent); 2 coronaries by-pass have been done in 2 patients. One patients refused surgery. Insignificant atheroumatous coronary lesions have been detected in 4 patients. In this study, the stress echocardiography enabled to detect a silent myocardial ischaemia in 15/16 patients (93.7%) and to treat 10/15 patients (66.5% including 20% by surgery).


CONCLUSIONS
The sensibility of this test must be compared to the thallium scintigraphy coupled with dipyridamole as part of a larger prospective study.
Hadj-Abdelkader
M
M
Service de néphrologie, unité d'hemodialyse adultes, hôpital Hôtel-Dieu, bd Léon Malfreyt, 63000 Clermont-Ferrand. ahadj@chu-clermontferrand.fr
Rozand
J Y
JY
Alphonse
J C
JC
Guret
Cl
C
Deteix
P
P
D000368:Aged; D002316:Cardiotonic Agents; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology*; D006435:Renal Dialysis; D012680:Sensitivity and Specificity
D002316:Cardiotonic Agents; D004280:Dobutamine