986-79 Identification of Coronary Artery Disease and Assessment of Prognosis in Patients with Chronic Renal Failure: Role of Dobutamine Stress Echocardiography

Abstract

The evaluation of patients with chronic renal failure (CRF) for the presence of coronary artery disease (CAD) is a diagnostic challenge. Most non-invasive testing strategies have been hampered by suboptimal sensitivity and specificity, thus necessitating an invasive evaluation with coronary angiography (angio). The purpose of this study was to evaluate the diagnostic accuracy and prognostic implications of dobutamine stress echocardiography (DSE) in patients with CRF. Between 1/92 and 10/93, 97 consecutive patients underwent DSE for risk assessment prior to listing for renal transplantation. There were 61 males and 36 females with an average age of 47 +/- 12 years (range 21 to 69). There was an average of 3 cardiac risk factors/pt. DSE was positive in 29/97 (30%) patients. A total of 28 patients underwent angio (23 with positive DSE); 22 had CAD. DSE had a sensitivity of 95.7% (91.6% for single vessel, 100% for ≥ two vessel CAD) and specificity of 85.7%. Follow-up after DSE averaged 12 +/- 6.4 months. During this time 6 patients died (1 of cardiac causes). DSE revealed inducible ischemia in four, two of whom had multivessel CAD. No patient with a normal DSE had a cardiac event and only 2 died of any cause. A normal DSE identified a low risk population with a 97% probability of being free of cardiac complications or any death during follow-up. Renal transplantation was accomplished in 25 patients (mean age 44.7 ± 12.5 years). DSE was positive in 7 of these, 6 of whom underwent angio; all of whom had CAD. Four of these underwent intervention prior to clearance for transplant, two with single vessel CAD were managed medically without complications. No cardiac complications occurred in transplanted patients with normal DSE or after successful intervention. We conclude that DSE is a feasible and accurate technique for detecting CAD and assessing prognosis in patients with CRF. A normal DSE identifies a very low risk subset with a 97% 1 year event free survival and an abnormal DSE is an accurate marker of CAD in this patient population.