De Lima Jose Jayme G, Sabbaga Emil, Vieira Marcelo Luis C, de Paula Flavio J, Ianhez Luis E, Krieger Eduardo M, Ramires Jose Antonio F
Heart Institute (InCor), Brazil.
Hypertension. 2003 Sep;42(3):263-8. doi: 10.1161/01.HYP.0000087889.60760.87. Epub 2003 Aug 11.
Guidelines for the detection of coronary artery disease (CAD) and assess of risk in renal transplant candidates are based on the results of noninvasive testing, according to data originated in the nonuremic population. We evaluated prospectively the accuracy of 2 noninvasive tests and risk stratification in detecting CAD (>or=70% obstruction) and assessing cardiac risk by using coronary angiography (CA). One hundred twenty-six renal transplant candidates who were classified as at moderate (>or=50 years) or high (diabetes, extracardiac atherosclerosis, or clinical coronary artery disease) coronary risk underwent myocardial scintigraphy (SPECT), dobutamine stress echocardiography, and CA and were followed for 6 to 48 months. The prevalence of CAD was 42%. The sensitivities and negative predictive values for the 2 noninvasive tests and risk stratification were <75%. After 6 to 48 months, there were 18 cardiac events, 9 fatal. Risk stratification (P=0.007) and CA (P=0.0002) predicted the crude probability of surviving free of cardiac events. The probability of event-free survival at 6, 12, 24, 36, and 48 months were 98%, 98%, 94%, 94%, and 94% in patients with <70% stenosis on CA and 97%, 87%, 61%, 56%, and 54% in patients with >or=70% stenosis. Multivariate analysis showed that the sole predictor of cardiac events was critical coronary lesions (P=0.003). Coronary angiography may still be necessary for detecting CAD and determining cardiac risk in renal transplant candidates. The data suggest that current algorithms based on noninvasive testing in this population should be revised.
根据源自非尿毒症人群的数据，检测冠状动脉疾病（CAD）及评估肾移植候选者风险的指南基于非侵入性检测结果。我们前瞻性地评估了两种非侵入性检测及风险分层在检测CAD（≥70%阻塞）和通过冠状动脉造影（CA）评估心脏风险方面的准确性。126例被分类为中度（≥50岁）或高度（糖尿病、心脏外动脉粥样硬化或临床冠状动脉疾病）冠状动脉风险的肾移植候选者接受了心肌闪烁显像（SPECT）、多巴酚丁胺负荷超声心动图和CA检查，并随访6至48个月。CAD的患病率为42%。两种非侵入性检测及风险分层的敏感性和阴性预测值均<75%。6至48个月后，发生了18例心脏事件，9例死亡。风险分层（P = 0.007）和CA（P = 0.0002）预测了无心脏事件存活的粗略概率。CA显示狭窄<70%的患者在6、12、24、36和48个月时无事件存活的概率分别为98%、98%、94%、94%和94%，而狭窄≥70%的患者分别为97%、87%、61%、56%和54%。多变量分析表明，心脏事件的唯一预测因素是严重冠状动脉病变（P = 0.003）。冠状动脉造影对于检测肾移植候选者的CAD和确定心脏风险可能仍然是必要的。数据表明，目前基于该人群非侵入性检测的算法应予以修订。
