Exeqüibilidade, segurança e acurácia do ecocardiograma sob estresse com dobutamina/ atropina para detecção de doença arterial coronariana em candidatos a transplante renal

Abstract

Objective: To evaluate the feasibility, safety and accuracy of dobutamine/atropine stress echocardiography (DASE) for the detection of coronary artery disease (CAD) in renal transplant candidates. Methods:Patients candidates to renal transplant were submitted consecutively to DASE and coronary angiography. TheResults: 148 patients underwent the DASE and the coronary angiography. Mean age was 52 ± 9 years, and 69% of the patients were males; 27% had diabetic nephropathy and 73% had LVH; 63% were asymptomatic; 36% and 22% presented coronary sensibility, specificity and accuracy for the diagnosis of coronary obstruction > 50% were 53% (CI:45-61), 87% (CI:81-93), and 75% (CI:63-83) respectively. For coronary obstruction > 70% these values were, respectively, 71% (CI:64-92), 85% (CI:79-91) and 81% (CI:75-87). The sensibility to detect univessel and multivessel disease was 41% (CI:19-63) and 78% (CI:64-92), respectively. Conclusion:The DASE was practical and safe; however, it presented a poor result for the detection of CAD regarding obstructions > 50%. It can be a useful screening for the detection of CAD in candidates with obstructions > 70% and multivessel disease.

Cardiovascular risk assessment in kidney transplantation

“…[27][28][29][30][31][32][33][34][35] In addition to stress tests, biomarkers such as cardiac troponins in asymptomatic patients with advanced CKD may have prognostic value for risk stratification beyond the traditional use of rising troponins to detect acute coronary syndrome. Persistent elevations in troponin may reflect cardiac stress beyond CAD, such as left ventricular hypertrophy, diastolic dysfunction, and volume overload.…”

“…For DSE, estimates for the sensitivity and specificity ranged from 37 to 95% and 71 to 95%, respectively. [27][28][29][30][31] Reported sensitivity and specificity for MPS ranged from 37 to 80% and 37 to 73%, respectively. 29,32,33 In 2011, Wang et al 34 Only two studies had head-to-head comparisons, which seemed to show superior specificity of DSE over MPS and equivalent sensitivity.…”

“…Recent changes in lipid management recommendations following the Study of Heart and Renal Protection (SHARP) trial, as well as new treatment guidelines from both the ACC/AHA and Kidney Disease: Improving Global Outcomes (KDIGO), may improve medical riskfactor management, potentially further reducing the benefit of invasive procedures. [83][84][85] Finally, the resource utilization of widespread screening is substantial while the yield is low; observational studies show that fewer than 10% of those screened go on to coronary intervention, 27,30,34,49,[86][87][88] consuming healthcare resources, which could potentially be applied elsewhere.…”

Low Prevalance of Major Events Adverse to Exercise Stress Echocardiography

“…13 - 18 Even though the use of drugs such stressors has proven safe, recent literature has firmly focused on its complications. 19 - 29 …”

Cardiovascular Evaluation of Renal Transplant Recipients

“…The sensitivity of DSE and MPS varies from 0.44 to 0.89 and 0.29 to 0.92 whereas the specificity of DSE and MPS varies from 0.71 to 0.94 and 0.67 to 0.89, respectively, depending on the type of stress and the number of coronary stenosis>70% [29][30][31][32]. In a meta-analysis of 12 studies involving either thallium-201 MPS or DSE, published in 2003, it was shown that risk of myocardial infarction increased 6 times, and risk of cardiac death increased 4 times in patients with inducible ischemia when compared those without inducible ischemia.…”