title: Cardiac stress test as a risk-stratification tool for posttransplant cardiac outcomes in diabetic kidney transplant recipients.
abstract: BACKGROUND
  The utility of cardiac stress testing as a risk-stratification tool before kidney transplantation remains debatable owing to discordance with coronary angiography and outcome yields at different centers.
  
  
  METHODS
  We conducted a retrospective study of 273 diabetic kidney transplant recipients from 2006 to 2010. By protocol, all diabetic patients underwent pharmacological radionucleotide stress test or dobutamine stress echocardiography before transplant. We compared the 1-year cardiac outcomes between those with negative stress test results and those with positive stress test results.
  
  
  RESULTS
  Patients with a positive stress test result (n=67) underwent coronary angiogram, and significant coronary artery disease (≥70% coronary stenosis) was found in 35 (52.2%) patients. Of the latter, 32 (91.4%) underwent cardiac revascularization (24 underwent cardiac stenting and 8 underwent coronary artery bypass grafting). The rest (n=35) were treated medically. Within 1 year after transplant, the group with positive stress test results experienced more cardiac events (34.3% vs. 3.9%, P<0.001) including acute myocardial infarction (22.4% vs. 3.4%, P<0.001) and ventricular arrhythmias (8.9% vs. 0.05%, P=0.001), higher all-cause mortality (19.4% vs. 4.8%, P<0.001), and cardiac mortality (17.9% vs. 0.9%, P<0.001) compared with the group with negative stress test results.
  
  
  CONCLUSIONS
  In this diabetic population, stress testing showed positive and negative predictive values of 34.3% and 96.1%, respectively. Pharmacological cardiac stress testing provided excellent risk stratification in diabetic kidney transplant recipients.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, The Ohio State University College of Medicine and Public Health, Columbus, OH, USA. nsing1@lsuhsc.edu
authors.forename: Neeraj
authors.initials: N
authors.lastname: Singh
authors.forename: Samir
authors.initials: S
authors.lastname: Parikh
authors.forename: Udayan
authors.initials: U
authors.lastname: Bhatt
authors.forename: Jon
authors.initials: J
authors.lastname: Vonvisger
authors.forename: Uday
authors.initials: U
authors.lastname: Nori
authors.forename: Ayesha
authors.initials: A
authors.lastname: Hasan
authors.forename: Srinivas
authors.initials: S
authors.lastname: Samavedi
authors.forename: Kenneth
authors.initials: K
authors.lastname: Andreoni
authors.forename: Mitchell
authors.initials: M
authors.lastname: Henry
authors.forename: Ronald
authors.initials: R
authors.lastname: Pelletier
authors.forename: Amer
authors.initials: A
authors.lastname: Rajab
authors.forename: Elmahdi
authors.initials: E
authors.lastname: Elkhammas
authors.forename: Todd
authors.initials: T
authors.lastname: Pesavento
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000401:mortality*; D004280:Dobutamine; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine