title: Should we do cardiac stress tests in asymptomatic renal transplant candidates?
abstract: BACKGROUND
  There is controversy regarding the best method and benefit of cardiac evaluation of asymptomatic renal transplant candidates. The positive predictive value of ischemia on a noninvasive stress test was ∼5%-10% in Kidney Disease Outcomes Quality Initative (KDOQI), American Society of Transplantation (AST), and Lisbon guidelines. We compared prediction of cardiac events with the use of simple transthoracic echocardiography versus a noninvasive stress test in asymptomatic candidates.
  
  
  METHODS
  We selected asymptomatic patients with good functional capacity who would be recommended a cardiac stress test by both KDOQI and AST guidelines, we excluding those with a history of cardiovascular disease. Group A (n = 124) underwent only echocardiography, and group B (n = 41) underwent echocardiography and noninvasive stress test. We measured the incidences of cardiac events and cardiac death within 3 years after transplantation.
  
  
  RESULTS
  The mean age of group A was 39 ± 7 and group B 40 ± 5 years. Diabetic patients among groups A and B were 8.8% (11/124) and 9.7% (4/41), respectively. The mean duration of dialysis was 2.9 ± 5 years. Only 4 group B patients showed a positive result on the noninvasive stress test, but they had no obstructive disease on coronary angiograms. The incidences of ischemic heart disease after transplantation of groups A and B were 4% (5/124) and 4.8% (2/41), respectively (P = .88). There was no death due to cardiac events in either group.
  
  
  CONCLUSIONS
  In this study, simple echocardiography showed an ability similar to stress test to predict ischemic heart disease in asymptomatic renal transplant candidates with good functional capacity, relatively younger age, lower prevalence of diabetes, and shorter duration of dialysis.
authors.affiliation: Department of Surgery, Gachon University of Medicine and Science, Incheon, Korea.
authors.forename: Y H
authors.initials: YH
authors.lastname: Park
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Chang
authors.forename: J Y
authors.initials: JY
authors.lastname: Jung
authors.forename: H
authors.initials: H
authors.lastname: Ro
authors.forename: W K
authors.initials: WK
authors.lastname: Chung
authors.forename: H H
authors.initials: HH
authors.lastname: Lee
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004562:Electrocardiography; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged