Stress echocardiography for risk stratification in patients with end-stage renal disease undergoing renal transplantation.
BACKGROUND
The predictive accuracy of stress echocardiography (SE) for adverse cardiac events has been variable in the population with end-stage renal disease undergoing renal transplantation (RT).


METHODS
We performed a retrospective study of 149 patients who had pretransplant SE before RT between 1997 and 2003. Patients were followed up for a mean of 2.85 years for major adverse cardiovascular events (MACE).


RESULTS
Of 149 patients studied, 139 had a negative SE, 65% were African American; 12 underwent cardiac catheterization. Only 1 patient required pre-RT revascularization. Sixteen MACE occurred over the follow-up period. SE had 37.5% sensitivity, 95.3% specificity, 33.3% positive predictive value, and 96.1% negative predictive value for MACE in the first year post-RT. First-year posttransplant event rates were 4.0% versus 30% (P < .001) for patients with a negative SE and positive SE, respectively. Multivariate predictors of MACE were positive SE (hazard ratio [HR] 7.64), hemoglobin less than 11 g/dL post-RT (HR 4.44), and calcium channel blocker use posttransplant (HR 2.90).


CONCLUSIONS
A negative SE has low incidence of MACE in this intermediate- to high-risk patient subset. A positive SE predicts a sevenfold higher risk of cardiovascular events regardless of the need for revascularization before the transplant.
Tita
Cristina
C
Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA.
Karthikeyan
Vanji
V
Stroe
Alice
A
Jacobsen
Gordon
G
Ananthasubramaniam
Karthik
K
D004280:Dobutamine; D004452:Echocardiography / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004280:Dobutamine