Prognostic value of inducible myocardial ischemia in predicting cardiovascular events after renal transplantation.
BACKGROUND
The aims of the present study were to determine the prevalence of inducible myocardial ischemia (IMI) in renal transplant recipients (RTR) more than 50 years old, to identify predictors of IMI, and to search for its prognostic value.


METHODS
Among the 377 renal transplantations performed between 1989 and 1998 in a single institution, 120 were done in patients > or =50 years old, and 97 were recruited for the study. During the last quarter of 1998, all of them underwent an exercise test (EST), an exercise-thallium 201 single photon emission computed tomography coupled with dipyridamole (SPECT), and 81% of them had a dobutamine stress echocardiography (DSE). Patients with IMI subsequently underwent coronary angiography to detect coronary stenosis.


RESULTS
IMI was present in 12 of the 97 patients (10%). The diagnosis was evidenced by EST in four cases, by SPECT in 11 cases, and DSE in three cases. Five of these 12 patients (42%) had significant coronary artery stenosis (> or =50%). Multivariate analysis of several pre- and post-transplant variables evidenced acute rejection and left ventricular hypertrophy as significant correlates of IMI (both P < 0.03). Patients were prospectively followed-up for 48 months for the occurrence of major cardiovascular events. Kaplan-Meier analysis revealed a significant increase in cardiovascular events in the IMI group (P < 0.0001). In addition, the Cox proportional hazards model revealed that IMI and diabetes mellitus had an independent significant effect on the occurrence of major cardiovascular events.


CONCLUSIONS
IMI was present in 10% of RTR aged > or =50 years, and was predicted by acute rejection and left ventricular hypertrophy. IMI had a strong effect on major cardiovascular events in this population.
Service de Néphrologie et Hémodialyse, Hôpital de la Conception, Marseille, France. bdussol@mail.ap-hm.fr
Bertrand
B
Dussol
Jean-Louis
JL
Bonnet
Jerome
J
Sampol
Bernard
B
Savin
Catherine
C
De La Forte
Olivier
O
Mundler
Gilbert
G
Habib
Sophie
S
Morange
Karine
K
Barrau
Anderson
A
Loundoun
Henri
H
Vacher-Coponat
Yvon
Y
Berland
D000208:Acute Disease; D000368:Aged; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon