title: Dobutamine stress echocardiography in the diagnosis of asymptomatic ischemic heart disease in patients with chronic kidney disease--review of literature and single-center experience.
abstract: BACKGROUND
  Coronary artery disease (CAD) may be present in kidney transplant (KT) candidates without the presence of CAD clinical symptoms. This study joins an ongoing discussion about appropriate noninvasive diagnostic approaches for ischemic heart disease (IHD) assessment and patient selection for revascularization procedures. The aim of this study was to evaluate the role of dobutamine stress echocardiography (DSE) in IHD diagnosis in initially asymptomatic maintenance hemodialysis (HD) patients.
  
  
  METHODS
  Forty HD patients aged 52.4 ± 2.0 years, were studied for 2.5 years. At inclusion, they were free of both symptoms and history of IHD. Standard electrocardiography (ECG), chest X-ray, standard echocardiography, DSE, 24-hour Holter ECG, and Doppler ultrasonography (carotids and lower extremities) were performed. Results were analyzed according to a predefined diagnostic algorithm.
  
  
  RESULTS
  DSE yielded negative results in all patients. Left ventricular (LV) ejection fraction ≤ 60%, LV hypertrophy, and Holter ECG silent ischemia features were noticed in 15%, 70%, and 10% of patients, respectively. Atherosclerotic lesions in lower extremities and carotid arteries were present in 50% and 37.5% of patients, respectively. During the follow-up, 9/40 patients died, including 6 cardiovascular (CV) deaths: 2 with intermediate and 4 with high CV risk according to the proposed algorithm.
  
  
  CONCLUSIONS
  In asymptomatic KT candidates, not only DSE, but also other noninvasive tests (eg, echocardiography and Doppler ultrasonography of the carotid and peripheral arteries) along with a detailed profile of the remaining CV risk factors should be performed and analyzed. Defined composition of risk factors and particular changes in noninvasive tests may be an indication for coronary angiography.
authors.affiliation: Department of Transplantation, Provincial Specialist Hospital, Olsztyn, Poland. Electronic address: beatagiergielewicz@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Januszko-Giergielewicz
authors.affiliation: Clinic of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Dębska-Ślizień
authors.affiliation: Department of Cardiology, Provincial Specialist Hospital, Olsztyn, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Górny
authors.affiliation: Ultrasonography and Fine Needle Biopsy Laboratory, Provincial Specialist Hospital, Olsztyn, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Kozak
authors.affiliation: Ultrasonography and Fine Needle Biopsy Laboratory, Provincial Specialist Hospital, Olsztyn, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Oniszczuk
authors.affiliation: University Clinical Hospital, University of Warmia and Mazury, Olsztyn, Poland.
authors.forename: L
authors.initials: L
authors.lastname: Gromadziński
authors.affiliation: Department of Cardiac Diagnostics, 2nd Chair of Cardiology, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Dorniak
authors.affiliation: Department of Cardiac Diagnostics, 2nd Chair of Cardiology, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Dudziak
authors.affiliation: Department of Transplantation, Provincial Specialist Hospital, Olsztyn, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Malinowski
authors.affiliation: Clinic of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Rutkowski
mesh_terms: D058070:Asymptomatic Diseases; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D004452:Echocardiography; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D007866:Leg / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler