Department of Internal Medicine, Division of Nephrology, The Ohio State University College of Medicine and Public Health, Columbus, OH, USA.
Transplantation. 2012 Dec 27;94(12):1224-9. doi: 10.1097/TP.0b013e31827147d8.
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.
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.
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.
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.
由于与不同中心的冠状动脉造影和结果不一致，心脏应激测试作为肾移植前风险分层工具的效用仍存在争议。
我们对 2006 年至 2010 年间的 273 例糖尿病肾病移植受者进行了回顾性研究。根据方案，所有糖尿病患者在移植前均进行药物放射性核素应激试验或多巴酚丁胺超声心动图检查。我们比较了阴性应激试验结果和阳性应激试验结果的患者 1 年心脏结局。
阳性应激试验结果的患者（n=67）进行了冠状动脉造影，发现 35 例（52.2%）患者存在显著的冠状动脉疾病（≥70%冠状动脉狭窄）。后者中，32 例（91.4%）进行了心脏血运重建（24 例进行了心脏支架置入术，8 例进行了冠状动脉旁路移植术）。其余（n=35）接受了药物治疗。移植后 1 年内，阳性应激试验组的心脏事件发生率较高（34.3%比 3.9%，P<0.001），包括急性心肌梗死（22.4%比 3.4%，P<0.001）和室性心律失常（8.9%比 0.05%，P=0.001），全因死亡率较高（19.4%比 4.8%，P<0.001）和心脏死亡率（17.9%比 0.9%，P<0.001）与阴性应激试验组相比。
在该糖尿病人群中，应激试验的阳性和阴性预测值分别为 34.3%和 96.1%。药物心脏应激试验为糖尿病肾病移植受者提供了极好的风险分层。
