Clinical, resting echo and dipyridamole stress echocardiography findings for the screening of renal transplant candidates.
BACKGROUND
Preoperative screening for coronary artery disease is recommended in high-risk renal transplant candidates. Aim of this study was to prospectively assess the value of a comprehensive risk stratification strategy including clinical, resting echo, and dipyridamole stress echo findings before renal transplantation.


METHODS
The study group consisted of 71 renal transplant candidates (47 men; age 54+/-11 years) fulfilling one or more of the following high-risk clinical criteria: history of coronary artery disease, wall motion abnormalities at resting echo, dialysis dependency lasting >5 years, presence of 2 or more risk factors. Clinical history, resting echo, and dipyridamole stress echo (up to 0.84 mg over 10 min + atropine up to 1 mg) were obtained in all subjects.


RESULTS
Mean number of risk factors was 2.5+/-1.0. Known coronary artery disease and diabetes were present, respectively, in 2 (3%) and 11 (15%) persons. No patient had left ventricular ejection fraction <45%. Left ventricular hypertrophy was found in 53 (74%) cases. Stress echo showed 100% safety and 97% overall feasibility. Inducible ischemia (new wall motion abnormalities) was detected in 3 (4%) subjects. During follow-up (36+/-12 months), 8 (11%) cardiac events occurred: 2 deaths, 2 myocardial infarctions, 3 coronary interventions, and 1 pulmonary edema. The perioperative period and subsequent follow-up (22+/-12 months) was uneventful among 32 patients who received renal transplantation. Four-year event-free survival was 92% in those without ischemia; it was 96% in the non-diabetic population. Diabetes (HR=4.78), age (HR=1.14), and left ventricular mass index (HR=1.02) were independent prognostic indicators among clinical and resting echo variables. The global chi-square of the statistical model was 18.8; it increased to 27.3 (+45%) after the addition of stress echo result.


CONCLUSIONS
Renal transplant candidates can undergo effective stratification of risk by combining clinical, resting echo and dipyridamole stress echo findings.
Cortigiani
Lauro
L
Division of Cardiology, Lucca Hospital, 55032 Lucca, Italy. lacortig@tin.it
Desideri
Alessandro
A
Gigli
Guido
G
Vallebona
Alessandro
A
Terlizzi
Raffaele
R
Giusti
Riccardo
R
Rossi
Barbara
B
Solari
Paolo
P
Antonelli
Alessandro
A
Bigi
Riccardo
R
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000175:diagnosis; D004176:Dipyridamole; D018572:Disease-Free Survival; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006339:Heart Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010726:Phosphodiesterase Inhibitors; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome
D010726:Phosphodiesterase Inhibitors; D004176:Dipyridamole