Non-Invasive Cardiac Investigations in Patients Awaiting Renal Transplantation

Langford, E J; Belder, Adam J. de; Cairns, Hugh; Hendry, Bruce; Wainwright, R. J.

doi:10.1177/014107689709000306

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…Another study with that population has shown that 44% of those undergoing exercise ECG did not reach 85% of the predicted heart rate. 10 The use of pharmacological stress tests in association with echocardiographic images (stress echocardiography) seems to be a valid alternative for assessing the presence of obstructive coronary artery disease in patients with renal dysfunction. Nevertheless, this method has the disadvantage of largely depending on the examiner.…”

Section: Assessment Of Atherosclerosis In Ckdmentioning

confidence: 99%

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

Bucharles¹,

Varela²,

Barberato³

et al. 2010

J. Bras. Nefrol.

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Cardiovascular disease is the leading cause of death in the set of chronic kidney disease (CKD) patients, whether on renal replacement therapy or conservative treatment. A better understanding of cardiovascular risk factors, diagnostic approach and management are central keys to develop strategies to reduce cardiovascular mortality among those patients. This review article discusses some aspects of pathophysiology, investigation methods and current treatment of cardiovascular disease in CKD patients.

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Section: Assessment Of Atherosclerosis In Ckdmentioning

confidence: 99%

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

Bucharles¹,

Varela²,

Barberato³

et al. 2010

J. Bras. Nefrol.

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“…Concerns about safety in performing the test in transplant candidates with limited mobility may further limit its utilization. Failure to achieve the target heart rate impairs the capture of sufficient diagnostic information [29] , and ambiguity in correlating ECG findings to territorial ischemia will lead to a decision to pursue additional forms of stress testing in most cases. Testing for functional cardiovascular reserve [30,31] instead may be superior for prognostication although these tests have not been widely adapted.…”

Section: Exercise Stress Testingmentioning

confidence: 99%

Screening for cardiovascular disease before kidney transplantation

Palepu

Prasad

2015

WJT

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Pre-kidney transplant cardiac screening has garnered particular attention from guideline committees as an approach to improving post-transplant success. Screening serves two major purposes: To more accurately inform transplant candidates of their risk for a cardiac event before and after the transplant, thereby informing decisions about proceeding with transplantation, and to guide pre-transplant management so that posttransplant success can be maximized. Transplant candidates on dialysis are more likely to be screened for coronary artery disease than those not being considered for transplantation. Thorough history and physical examination taking, resting electrocardiography and echocardiography, exercise stress testing, myocardial perfusion scintigraphy, dobutamine stress echocardiography, cardiac computed tomography, cardiac biomarker measurement, and cardiac magnetic resonance imaging all play contributory roles towards screening for cardiovascular disease before kidney transplantation. In this review, the importance of each of these screening procedures for both coronary artery disease and other forms of cardiac disease are discussed.

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“…A report of 95 patients with ESRD found that exercise electrocardiogram testing was problematic in that 44% did not achieve the target heart rate (85% of maximum predicted heart rate) and no CAD that required intervention was identified by exercise testing (24). Furthermore, the symptom of angina pectoris on stress testing has a sensitivity and a specificity of 65 and 66%, respectively.…”

Section: Diagnosis Of Cad In Esrdmentioning

confidence: 99%

Coronary Artery Disease

McCullough

2007

Clinical Journal of the American Society of Nephrology

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Coronary heart disease is the most common cause of death in the general population and in patients with ESRD. The principles of cardiovascular risk assessment and management apply to both populations. Advances in noninvasive coronary artery imaging have improved early detection of subclinical disease. The goals of medical management of coronary disease are to modify the natural history of disease and to improve the symptoms of angina. Coronary revascularization poses a different risk and benefit equation in the ESRD population. In stable ESRD with multivessel coronary artery disease, coronary bypass surgery, despite the upfront risks of stroke, myocardial infarction, and chest wound infection, seems to be a favored approach. In patients with ESRD and acute coronary syndromes, percutaneous coronary intervention on the target vessel has been associated with the most favorable outcomes. This article explores the clinical issues with respect to coronary artery disease in patients with ESRD.Clin J Am Soc Nephrol 2: 611-616, 2007611-616, . doi: 10.2215 C oronary heart disease is the leading cause of death in the US general population. With the obesity pandemic and the expected worsening of cardiovascular risk factors in the general population, the incidence and the prevalence of heart disease is expected to rise. Coronary artery disease (CAD) is the leading cause of death in patients with chronic kidney disease (CKD): Of the more than 320,000 patients with ESRD that requires dialysis or kidney transplantation in the United States, half will die from cardiovascular causes, and patients with milder degrees of CKD are more likely to die of CAD than to develop kidney failure that requires renal replacement therapy (1).The observational studies concerning CAD and ESRD have revealed the following: (1) By the time patients reach dialysis, approximately 70% have significant coronary artery calcification indicative of coronary atherosclerosis, (2) patients with CAD and ESRD have markedly increased mortality over the general population, (3) treatment with disease-modifying therapy that is proved to reduce rates of (MI) or death (e.g., aspirin, ␤ adrenergic receptor blockers [BB], angiotensin-converting enzyme inhibitors [ACEI], 3-methylglutaryl CoA reductase inhibitors or statins) are used less frequently in patients with ESRD than in the general population, (4) noninvasive imaging seems to have less precision and accuracy in patients with ESRD, and (5) patients who have ESRD and are selected for revascularization with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) have improved survival compared with those who are treated with medical therapy alone (2-6). Table 1 presents a summary of CAD risk reduction, diagnosis, and management principles. Recommendations in Table 1 present a task list for optimal (not minimal) clinical goals and go beyond many current professional society guidelines concerning the individual treatment targets. ESRD: More Than a Coronary Heart Risk EquivalentPatients with ES...

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Non-Invasive Cardiac Investigations in Patients Awaiting Renal Transplantation

Cited by 9 publications

References 4 publications

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

Avaliação e manejo da doença cardiovascular em pacientes com doença renal crônica

Screening for cardiovascular disease before kidney transplantation

Coronary Artery Disease

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