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Cardiac stress test as a risk-stratification tool for posttransplant cardiac outcomes in diabetic kidney transplant recipients.
- Source :
-
Transplantation [Transplantation] 2012 Dec 27; Vol. 94 (12), pp. 1224-9. - Publication Year :
- 2012
-
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.<br />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.<br />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.<br />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.
- Subjects :
- Aged
Cardiotonic Agents
Coronary Artery Disease therapy
Dobutamine
Female
Humans
Male
Middle Aged
Myocardial Infarction diagnostic imaging
Myocardial Infarction mortality
Myocardial Infarction therapy
Myocardial Revascularization
Predictive Value of Tests
Prevalence
Radionuclide Imaging
Retrospective Studies
Risk Assessment methods
Risk Factors
Sensitivity and Specificity
Tachycardia, Ventricular diagnostic imaging
Tachycardia, Ventricular mortality
Tachycardia, Ventricular therapy
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease mortality
Diabetic Nephropathies mortality
Exercise Test methods
Kidney Transplantation mortality
Postoperative Complications mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 94
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 23263447
- Full Text :
- https://doi.org/10.1097/TP.0b013e31827147d8