多巴酚丁胺负荷超声心动图以及静息而非运动心电图可预测肾移植候选者的严重冠状动脉疾病。

Dobutamine stress echocardiography and the resting but not exercise electrocardiograph predict severe coronary artery disease in renal transplant candidates.

作者信息

Sharma Rajan, Pellerin Denis, Gaze David C, Gregson Helen, Streather Christopher P, Collinson Paul O, Brecker Stephen J D

机构信息

Department of Cardiology, E Level East Wing, Mailpoint 46, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.

出版信息

Nephrol Dial Transplant. 2005 Oct;20(10):2207-14. doi: 10.1093/ndt/gfi005. Epub 2005 Jul 19.

DOI:10.1093/ndt/gfi005

PMID:16030034

Abstract

BACKGROUND

After renal transplantation half of all deaths are cardiac, so prior detection and treatment of severe coronary artery disease (CAD) is advocated. The aim of this study was to identify non-invasive predictors of severe CAD in a group of renal transplant candidates.

METHODS

One hundred and twenty-five renal transplant candidates (mean age 52+/-12 years, 80 male, mean creatinine 608+/-272 micromol/l) were studied. All had coronary angiography, dobutamine stress echocardiography, and resting and exercise electrocardiograph (ECG). Severe CAD was defined as luminal stenosis >70% by visual estimation in at least one epicardial artery. The resting ECG was recorded as abnormal if there was evidence of pathological Q waves, left ventricular hypertrophy, ST depression or elevation > or=1 mm, T wave inversion or bundle branch block. Total exercise time, maximal ST segment change, maximal heart rate and systolic blood pressure, limiting symptoms and Duke score were calculated during the exercise ECG test.

RESULTS

Of the patients, 36 (29%) had severe CAD, 55% were on dialysis and 39% were diabetic. Patients with severe CAD were significantly older (P<0.001), had higher total cholesterol (P = 0.05), higher CRP level (P = 0.05), larger left ventricular (LV), end systolic and end diastolic diameter (P = 0.007 for each), and lower LV ejection fraction (P = 0.01). A significantly higher percentage were diabetic (P = 0.05), had previous graft failure (P = 0.05), mitral annular calcification (P = 0.04), an abnormal resting ECG (P = 0.001) and positive stress echo result (P<0.001). Cardiac symptoms and exercise ECG parameters were not significantly different in the two groups. Stepwise logistic regression identified an abnormal resting ECG (OR 7, 95% CI 2, 34, P = 0.013) and positive stress echo result (OR 23, 95% CI 6, 88, P<0.001) as independent predictors of severe CAD.

CONCLUSIONS

In selecting which potential renal transplant candidates should undergo coronary angiography, resting ECG and dobutamine stress echocardiography are the best predictors of severe CAD.

摘要

背景

肾移植后所有死亡病例中有一半是心脏相关的，因此提倡对严重冠状动脉疾病（CAD）进行早期检测和治疗。本研究的目的是在一组肾移植候选者中识别严重CAD的非侵入性预测指标。

方法

对125例肾移植候选者（平均年龄52±12岁，男性80例，平均肌酐608±272微摩尔/升）进行研究。所有患者均接受冠状动脉造影、多巴酚丁胺负荷超声心动图检查以及静息和运动心电图（ECG）检查。严重CAD定义为至少一条心外膜动脉经视觉评估管腔狭窄>70%。如果静息心电图有病理Q波、左心室肥厚、ST段压低或抬高≥1毫米、T波倒置或束支传导阻滞的证据，则记录为异常。在运动心电图测试期间计算总运动时间、最大ST段变化、最大心率和收缩压、限制症状和杜克评分。

结果

患者中，36例（29%）患有严重CAD，55%正在接受透析，39%患有糖尿病。患有严重CAD的患者年龄显著更大（P<0.001），总胆固醇更高（P = 0.05），CRP水平更高（P = 0.05），左心室（LV）、收缩末期和舒张末期直径更大（每项P = 0.007），左心室射血分数更低（P = 0.01）。糖尿病患者比例显著更高（P = 0.05），既往有移植失败史（P = 0.05），二尖瓣环钙化（P = 0.04），静息心电图异常（P = 0.001），负荷超声心动图结果阳性（P<0.001）。两组的心脏症状和运动心电图参数无显著差异。逐步逻辑回归分析确定静息心电图异常（OR 7，95%CI 2，34，P = 0.013）和负荷超声心动图结果阳性（OR 23，95%CI 6，88，P<0.001）是严重CAD的独立预测指标。