Optimum Second Screening Point for Detection of Coronary Artery Disease in Hemodialysis Patients without Advanced Coronary Artery Disease

Joki, Nobuhiko; Tanaka, Yuri; Ishikawa, Hiroyasu; Takahashi, Yasunori; Iwakura, Yoshitsugu; Masuda, Haruka; Inishi, Yoji; Hase, Hiroki

doi:10.1159/000172617

Cited by 9 publications

(4 citation statements)

References 29 publications

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“…56 Of 100 hemodialysis patients with a normal coronary angiography and/or MPS, 5 developed a major adverse cardiac event during the second year following the test. 80 A normal MPS (normal global perfusion and left ventricular ejection fraction 445%) was associated with a 2-year cardiac event rate of 15%. 23 These data should be compared with cardiac event rates below 1% per year following a normal MPS in the general population.…”

Section: Who Deserves To Be Screened?mentioning

confidence: 97%

Should we screen for coronary artery disease in asymptomatic chronic dialysis patients?

Vriese

Vandecasteele

Bergh

et al. 2012

Kidney International

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The hemodialysis population is characterized by a high prevalence of 'asymptomatic' coronary artery disease (CAD), which should be interpreted differently from asymptomatic disease in the general population. A hemodynamically significant stenosis may not become clinically apparent owing to impaired exercise tolerance and autonomic neuropathy. The continuous presence of silent ischemia may cause heart failure, arrhythmias, and sudden death. Whether revascularization of an asymptomatic dialysis patient improves outcome remains a moot point, although several observational studies and one small RCT suggest a benefit. It can therefore be defended to screen asymptomatic dialysis patients for CAD. A number of noninvasive screening tests are available, but none has proved equally practical and reliable in the dialysis population as in the general population. Myocardial perfusion scintigraphy (MPS) before and after a pharmacological stress such as dipyridamole can reveal both ischemia and myocardial scarring. When compared with coronary angiography, low sensitivities were reported and attributed to impaired vasodilation to dipyridamole in dialysis patients. A more likely explanation is that not every anatomical stenosis will lead to impaired coronary blood flow on MPS. Numerous studies have shown an incremental prognostic value of dipyridamole-MPS over clinical data for prediction of adverse cardiac events, in some studies even over coronary angiography. Pending the availability of high-quality evidence, in our opinion asymptomatic dialysis patients could undergo dipyridamole-MPS, followed by coronary angiography in case of an abnormal scan. This combined physiological and anatomical evaluation of the coronary circulation allows us to determine which coronary stenosis is clinically relevant and therefore should be revascularized.

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Section: Who Deserves To Be Screened?mentioning

confidence: 97%

Should we screen for coronary artery disease in asymptomatic chronic dialysis patients?

Vriese

Vandecasteele

Bergh

et al. 2012

Kidney International

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“…The second possible explanation may relate to the results of our previous study [26]. In that study, we analyzed the survival rates for major adverse cardiac events in incident dialysis patients without CAD and found that even in patients without significant CAD, cardiac events occurred after 1 year of starting dialysis.…”

Section: Effect Of Cad Screening On Mortalitymentioning

confidence: 88%

Coronary artery disease screening and prognosis in incident dialysis patients

et al. 2016

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Background: Guidelines have recommended that physicians screen for coronary artery disease (CAD) at the initiation of dialysis. The purpose of this study was to examine the effects of CAD screening at the initiation of dialysis on prognosis after starting dialysis Methods: This retrospective cohort study involved 224 consecutive incident dialysis patients without advanced cardiac disease. Pharmacological stress myocardial perfusion imaging (MPI) was performed to routinely screen incident dialysis patients within 3 months of starting dialysis therapy. The influence of MPI on prognosis after starting dialysis was explored by the propensity score adjustment method. The study outcome was defined as all-cause mortality and cardiac death.

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“…They showed that no cardiovascular events were observed during the first year of HD in 100 patients without CAD at the initiation of dialysis and five events occurred during the second year of dialysis. They proposed that the optimum time to repeat screening for CAD might be at the end of the first year of dialysis . Our findings were consistent with their results.…”

Section: Discussionmentioning

confidence: 99%

Practical Approach to Evaluate Asymptomatic Coronary Artery Disease in End‐Stage Renal Disease Patients at the Initiation of Dialysis

et al. 2014

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The high prevalence of significant asymptomatic coronary artery disease (CAD) has been reported in patients with end-stage renal disease (ESRD) at the initiation of dialysis. However, the approach to evaluate asymptomatic CAD for these patients has not been established. The aim of this study is to assess the applicability of our practical approach at the initiation of dialysis. We prospectively enrolled 182 consecutive ESRD patients who initiated dialysis. After echocardiography as primary screening, pharmacologic stress thallium-201 scintigraphy and/or coronary angiography (CAG) were performed to diagnose CAD. The patients were classified into two groups: those with coronary artery stenosis by CAG (CAD+ group), those without coronary artery stenosis by CAG or with negative scintigraphy examination (CAD- group). Of the eligible 93 patients without the history of CAD, 22 patients were allocated to the CAD+ group (18 of 26 patients with abnormal echocardiography and 4 of 13 patients with positive scintigraphy examination) and 71 patients to the CAD- group. Patients were followed up for an average of 520 ± 304 days. The event-free survival rate of major adverse cardiac events was significantly lower in the CAD+ group than in the CAD- group (P < 0.001). There was no cardiovascular event including major adverse cardiac events, unstable angina, coronary revascularization or stroke in the CAD- group during the first year of dialysis. Patients without CAD diagnosed by our approach had favorable clinical outcomes. Our approach may be useful for screening of occult CAD in ESRD patients at the initiation of dialysis.

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Optimum Second Screening Point for Detection of Coronary Artery Disease in Hemodialysis Patients without Advanced Coronary Artery Disease

Cited by 9 publications

References 29 publications

Should we screen for coronary artery disease in asymptomatic chronic dialysis patients?

Should we screen for coronary artery disease in asymptomatic chronic dialysis patients?

Coronary artery disease screening and prognosis in incident dialysis patients

Practical Approach to Evaluate Asymptomatic Coronary Artery Disease in End‐Stage Renal Disease Patients at the Initiation of Dialysis

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