Reis G, Marcovitz P A, Leichtman A B, Merion R M, Fay W P, Werns S W, Armstrong W F
Department of Medicine, University of Michigan, Ann Arbor 48109-0119, USA.
Am J Cardiol. 1995 Apr 1;75(10):707-10. doi: 10.1016/S0002-9149(99)80658-4.
The cardiovascular evaluation of patients with end-stage renal disease (ESRD) has been hampered by the suboptimal sensitivity and specificity of currently employed diagnostic tests. Dobutamine stress echocardiography (DSE) is a recently developed technique which is accurate for the diagnosis of coronary artery disease (CAD) in general populations. The purpose of this study was to assess its diagnostic accuracy and prognostic implications in patients with ESRD. Patients with ESRD (n = 97) underwent DSE as part of a preoperative evaluation before being listed for renal transplantation. Patients were followed for 12 +/- 6 months (range 1 to 24) after the study. Rest and dobutamine stress echocardiograms were analyzed for regional and global function. Coronary angiography was performed in 30 patients, and 25 underwent renal transplantation in the follow-up period. DSE had a sensitivity of 95% (92% for 1-vessel, 100% for > or = 2-vessel disease), specificity of 86%, and accuracy of 90% for the detection of CAD. During the follow-up period, 6 patients died; DSE revealed inducible ischemia in 4, and catheterization before death revealed multivessel CAD in 2. Conversely, a normal DSE identified a very low risk population, with a 97% probability of being free of cardiac complications or death during the follow-up period. We conclude that DSE accurately identifies CAD in patients with ESRD and identifies a cohort of patients at low risk for cardiac complications.
终末期肾病（ESRD）患者的心血管评估一直受到目前所用诊断测试敏感性和特异性欠佳的影响。多巴酚丁胺负荷超声心动图（DSE）是一项最近开发的技术，在普通人群中对冠状动脉疾病（CAD）的诊断较为准确。本研究的目的是评估其在ESRD患者中的诊断准确性及预后意义。ESRD患者（n = 97）在被列入肾移植术前评估时接受了DSE检查。研究结束后，对患者进行了12±6个月（范围1至24个月）的随访。分析静息和多巴酚丁胺负荷超声心动图的局部和整体功能。30例患者接受了冠状动脉造影，25例在随访期间接受了肾移植。DSE检测CAD的敏感性为95%（单支血管病变为92%，两支或以上血管病变为100%），特异性为86%，准确性为90%。在随访期间，6例患者死亡；DSE显示4例有诱发性心肌缺血，死亡前的导管检查显示2例有多支血管CAD。相反，DSE正常的患者确定为低风险人群，随访期间无心脏并发症或死亡的概率为97%。我们得出结论，DSE能准确识别ESRD患者中的CAD，并识别出心脏并发症低风险的患者群体。
