USEFULNESS OF DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN DETECTING CORONARY-ARTERY DISEASE IN END-STAGE RENAL-DISEASE

The cardiovascular evaluation of patients with endstage renal disease (ESRD) has been hampered by the suboptimal sensitivity and specificity of currently employed diagnostic tests, Dobutamine stress echocardiog raphy (DSE) is a recently developed technique which is accurate for th e diagnosis of coronary artery disease (CAD) in general populations. T he purpose of this study was to assess ifs diagnostic accuracy and pro gnostic implications in patients with ESRD. Patients with ESRD (n = 97 ) underwent DSE as part of a preoperative evaluation before being list ed for renal transplantation. Patients were followed for 12 +/- 6 mont hs (range 1 to 24) after the study, Rest and dobutamine stress echocar diograms were analyzed for regional and global function. Coronary angi ography was performed in 30 patients, and 25 underwent renal transplan tation in the follow-vp period. DSE had a sensitivity of 95% (92% for 1-vessel, 100% for greater than or equal to 2-vessel disease), specifi city of 86%, and accuracy of, 90% for the detection of CAD. the follow -vp period, 6 patients died; DSE reinducible ischemia in 4, and cathet erization before death revealed multivessel CAD in 2. Conversely, a no rmal DSE identified a very low risk population, with a 97% probability of being free of cardiac complications or death during the follow-up period. We conclude that DSE accurately identifies CAD in patients wit h ESRD and identifies a cohort of patients at low risk for cardiac com plications.