Herzog C A, Marwick T H, Pheley A M, White C W, Rao V K, Dick C D
Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, Australia.
Am J Kidney Dis. 1999 Jun;33(6):1080-90. doi: 10.1016/S0272-6386(99)70145-9.
Prophylactic coronary revascularization may reduce the risk for cardiac events in diabetic renal transplant candidates. No published data exist on the accuracy of dobutamine stress echocardiography (DSE) for the diagnosis of angiographically defined coronary artery disease (CAD) in renal transplant candidates. The purpose of this study is to examine the accuracy of DSE for the detection of CAD in high-risk renal transplant candidates compared with coronary angiography. Fifty renal transplant candidates with diabetic nephropathy (39 patients) or end-stage renal disease (ESRD) from other causes (11 patients) underwent prospectively performed DSE, followed by quantitative coronary angiography (QCA) and qualitative visual assessment of CAD severity. Twenty of 50 DSE tests were positive for inducible ischemia. Twenty-seven patients (54%) had a stenosis of 50% or greater by QCA, 12 patients (24%) had a stenosis of greater than 70% by QCA, and 16 patients (32%) had a stenosis greater than 75% by visual estimation. The sensitivity and specificity of DSE for CAD diagnosis were respectively 52% and 74% compared with QCA stenosis of 50% or greater, 75% and 71% compared with QCA stenosis greater than 70%, and 75% and 76% for stenosis greater than 75% by visual estimate. On long-term follow-up (22.5 +/- 10.1 months), 6 of 30 patients (20%) with negative DSE results and 11 of 20 patients (55%) with positive DSE results had a cardiac death, myocardial infarction (MI), or coronary revascularization. Six of 27 patients (22%) with a QCA stenosis of 50% or greater had a cardiac death or MI compared with none of the 23 patients (0%) with QCA stenosis less than 50% (P = 0.025). We conclude that DSE is a useful but imperfect screening test for angiographically defined CAD in renal transplant candidates.
预防性冠状动脉血运重建术可能会降低糖尿病肾移植候选者发生心脏事件的风险。目前尚无已发表的数据表明多巴酚丁胺负荷超声心动图（DSE）在诊断肾移植候选者经血管造影确定的冠状动脉疾病（CAD）方面的准确性。本研究的目的是比较DSE与冠状动脉造影在检测高危肾移植候选者CAD方面的准确性。50例患有糖尿病肾病（39例）或其他原因导致的终末期肾病（ESRD）（11例）的肾移植候选者前瞻性地接受了DSE检查，随后进行了定量冠状动脉造影（QCA）以及对CAD严重程度的定性视觉评估。50例DSE检查中有20例出现诱发性缺血阳性。27例患者（54%）经QCA显示有50%或更高的狭窄，12例患者（24%）经QCA显示有大于70%的狭窄，16例患者（32%）经视觉估计有大于75%的狭窄。与QCA显示50%或更高狭窄相比，DSE诊断CAD的敏感性和特异性分别为52%和74%；与QCA显示大于70%狭窄相比，分别为75%和71%；经视觉估计大于75%狭窄时，分别为75%和76%。在长期随访（22.5±10.1个月）中，DSE结果为阴性的30例患者中有6例（20%）以及DSE结果为阳性的20例患者中有11例（55%）发生了心源性死亡、心肌梗死（MI）或冠状动脉血运重建。27例QCA显示50%或更高狭窄的患者中有6例（22%）发生了心源性死亡或MI，而23例QCA显示狭窄小于50%的患者中无一例发生（0%）（P = 0.025）。我们得出结论，DSE是一种用于肾移植候选者经血管造影确定的CAD的有用但并不完美的筛查试验。
