Clinical, resting echo and dipyridamole stress echocardiography findings for the screening of renal transplant candidates
| Autor: | Guido Gigli, Riccardo Giusti, Riccardo Bigi, Alessandro Antonelli, Paolo Solari, Raffaele Terlizzi, Alessandro Vallebona, Barbara Rossi, Lauro Cortigiani, Alessandro Desideri |
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| Rok vydání: | 2004 |
| Předmět: |
Adult
Male medicine.medical_specialty Heart Diseases Phosphodiesterase Inhibitors Blood Pressure Sensitivity and Specificity Disease-Free Survival Coronary artery disease Heart Rate Risk Factors Internal medicine Diabetes mellitus Stress Echocardiography Diabetes Mellitus Medicine Humans Prospective Studies Aged Kidney Ejection fraction business.industry Patient Selection Stroke Volume Dipyridamole Middle Aged medicine.disease Kidney Transplantation Transplantation medicine.anatomical_structure Treatment Outcome Italy Circulatory system Cardiology Kidney Failure Chronic Female Radiology Cardiology and Cardiovascular Medicine business medicine.drug Echocardiography Stress Follow-Up Studies |
| Zdroj: | International journal of cardiology. 103(2) |
| ISSN: | 0167-5273 |
| Popis: | Preoperative screening for coronary artery disease is recommended in high-risk renal transplant candidates. Aim of this study was to prospectively assess the value of a comprehensive risk stratification strategy including clinical, resting echo, and dipyridamole stress echo findings before renal transplantation.The study group consisted of 71 renal transplant candidates (47 men; age 54+/-11 years) fulfilling one or more of the following high-risk clinical criteria: history of coronary artery disease, wall motion abnormalities at resting echo, dialysis dependency lasting5 years, presence of 2 or more risk factors. Clinical history, resting echo, and dipyridamole stress echo (up to 0.84 mg over 10 min + atropine up to 1 mg) were obtained in all subjects.Mean number of risk factors was 2.5+/-1.0. Known coronary artery disease and diabetes were present, respectively, in 2 (3%) and 11 (15%) persons. No patient had left ventricular ejection fraction45%. Left ventricular hypertrophy was found in 53 (74%) cases. Stress echo showed 100% safety and 97% overall feasibility. Inducible ischemia (new wall motion abnormalities) was detected in 3 (4%) subjects. During follow-up (36+/-12 months), 8 (11%) cardiac events occurred: 2 deaths, 2 myocardial infarctions, 3 coronary interventions, and 1 pulmonary edema. The perioperative period and subsequent follow-up (22+/-12 months) was uneventful among 32 patients who received renal transplantation. Four-year event-free survival was 92% in those without ischemia; it was 96% in the non-diabetic population. Diabetes (HR=4.78), age (HR=1.14), and left ventricular mass index (HR=1.02) were independent prognostic indicators among clinical and resting echo variables. The global chi-square of the statistical model was 18.8; it increased to 27.3 (+45%) after the addition of stress echo result.Renal transplant candidates can undergo effective stratification of risk by combining clinical, resting echo and dipyridamole stress echo findings. |
| Databáze: | OpenAIRE |
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