This Article Full Text Full Text (PDF) All Versions of this Article: 42/3/263    most recent 01.HYP.0000087889.60760.87v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by De Lima, J. J. G. Articles by Ramires, J. A. F. Search for Related Content PubMed PubMed Citation Articles by De Lima, J. J. G. Articles by Ramires, J. A. F. Related Collections Coronary imaging: angiography/ultrasound/Doppler/CC

(Hypertension. 2003;42:263.)
© 2003 American Heart Association, Inc.

Scientific Contributions

Coronary Angiography Is the Best Predictor of Events in Renal Transplant Candidates Compared With Noninvasive Testing

Jose Jayme G. De Lima; Emil Sabbaga; Marcelo Luis C. Vieira; Flavio J. de Paula; Luis E. Ianhez; Eduardo M. Krieger; Jose Antonio F. Ramires

From the Heart Institute (InCor) (J.J.G.D., M.L.C.V., E.M.K., J.A.F.R.) and Renal Transplant Unit (E.S., F.J.deP., L.E.I.), Hospital das Clínicas, University of São Paulo Medical School, Brazil.

Correspondence to Jose De Lima, MD, Unidade de Hipertensão, Instituto do Coração, Rua Eneas Carvalho Aguiar, 44, 05403-000 São Paulo, SP, Brazil. E-mail hipjayme{at}incor.usp.br

Guidelines for the detection of coronary artery disease (CAD) and assess of risk in renal transplant candidates are based on the results of noninvasive testing, according to data originated in the nonuremic population. We evaluated prospectively the accuracy of 2 noninvasive tests and risk stratification in detecting CAD (70% obstruction) and assessing cardiac risk by using coronary angiography (CA). One hundred twenty-six renal transplant candidates who were classified as at moderate (50 years) or high (diabetes, extracardiac atherosclerosis, or clinical coronary artery disease) coronary risk underwent myocardial scintigraphy (SPECT), dobutamine stress echocardiography, and CA and were followed for 6 to 48 months. The prevalence of CAD was 42%. The sensitivities and negative predictive values for the 2 noninvasive tests and risk stratification were <75%. After 6 to 48 months, there were 18 cardiac events, 9 fatal. Risk stratification (P=0.007) and CA (P=0.0002) predicted the crude probability of surviving free of cardiac events. The probability of event-free survival at 6, 12, 24, 36, and 48 months were 98%, 98%, 94%, 94%, and 94% in patients with <70% stenosis on CA and 97%, 87%, 61%, 56%, and 54% in patients with 70% stenosis. Multivariate analysis showed that the sole predictor of cardiac events was critical coronary lesions (P=0.003). Coronary angiography may still be necessary for detecting CAD and determining cardiac risk in renal transplant candidates. The data suggest that current algorithms based on noninvasive testing in this population should be revised.

Key Words: transplantation • risk factors • coronary artery disease • hypertension, essential • kidney failure

This article has been cited by other articles:

				D. K. Hothi, L. Rees, J. Marek, J. Burton, and C. W. McIntyre Pediatric Myocardial Stunning Underscores the Cardiac Toxicity of Conventional Hemodialysis Treatments Clin. J. Am. Soc. Nephrol., April 1, 2009; 4(4): 790 - 797. [Abstract] [Full Text] [PDF]

				S. Gang, M. Dabhi, and M. M. Rajapurkar Ischaemia imaging in type 2 diabetic kidney transplant candidates is coronary angiography essential? Nephrol. Dial. Transplant., August 1, 2007; 22(8): 2334 - 2338. [Abstract] [Full Text] [PDF]

				L. H. W. Gowdak, F. J. de Paula, L. A. M. Cesar, E. E. M. Filho, L. E. Ianhez, E. M. Krieger, J. A. F. Ramires, and J. J. G. De Lima Diabetes and coronary artery disease impose similar cardiovascular morbidity and mortality on renal transplant candidates Nephrol. Dial. Transplant., May 1, 2007; 22(5): 1456 - 1461. [Abstract] [Full Text] [PDF]

				H.H.H. Feringa, J.J. Bax, O. Schouten, and D. Poldermans Ischemic heart disease in renal transplant candidates: Towards non-invasive approaches for preoperative risk stratification Eur J Echocardiogr, October 1, 2005; 6(5): 313 - 316. [Abstract] [Full Text] [PDF]

				S. Fishbane Cardiovascular Risk Evaluation before Kidney Transplantation J. Am. Soc. Nephrol., April 1, 2005; 16(4): 843 - 845. [Full Text] [PDF]

				C. A. Herzog, J. J. G. De Lima, E. Sabbaga, M. L. C. Vieira, F. J. de Paula, L. E. Ianhez, E. M. Krieger, and J. A. Ramires Stress Imaging in Renal Transplant Candidates * Response Hypertension, April 1, 2004; 43(4): e20 - e21. [Full Text] [PDF]