[Prognostic value of dobutamine stress echocardiography in patients with terminal renal insufficiency undergoing hemodialysis--a 5-year follow up].
BACKGROUND
Patients with end-stage renal failure have high morbidity and mortality rates due to cardiovascular complications. Screening for coronary heart disease in these patients is of utmost importance. The aim of this study was to investigate the prognostic value of the dobutamine test in patients on hemodyalisis during a 5-year follow-up period.


METHODS
During the pretransplantation period, 24 patients on chronic hemodialysis underwent echocardiography and dobutamine echocardiography. The average age of patients was 51.50 +/- 7.35 years. The mean duration of dialysis was 74 +/- 40 months.


RESULTS
The dobutamine stress test was positive in 50% of patients, and undefined in 12.5%. The wall motion score index before the test was 1, and after the test it was 1.54 +/- 0.27. There were no serious complications. Left ventricular mass, diastolic and systolic dimension and posterior wall were significantly higher in patients with positive dobutamine stress results and they were associated with late cardiac morbidity and mortality. Five-year survival in patients with positive dobutamine stress results was 33.3% and 52.3% in patients with negative dobutamine results. Causes of mortality were as follows: cardiac 45.4%, cerebrovascular 18.1%, other causes 36.4%. Cardiogical complications were not the cause of death in any of the patients with negative dobutamine results. In dobutamine positive group 62.5% died from cardiological complications. During the 5-year period, cardiac death and manifest coronary disease occurred in 75% of patients with positive dobutamine stress results and only in one patient with negative dobutamine results. Sensitivity was 75%, specificity 89% and positive predictive value 90%.


CONCLUSIONS
Dobutamine stress echocardiography has a good predictive value for future cardiac events in hemnodyalisis patients, and in screening for coronary disease.
Krotin
Mirjana
M
Klinicko-bolnicki centar Bezanijska kosa, Beograd. krotin@eunet.yu
Vuković
Dejana
D
Stojanović
Olivera
O
Milovanović
Branislav
B
Celeketić
Dusica
D
Blagojević
Radmila
R
D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications*
D004280:Dobutamine