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Feasibility of exercise stress echocardiography for cardiac risk assessment in chronic kidney disease patients prior to renal transplantation
Author(s) -
Nerlekar Nitesh,
Mulley William,
Rehmani Hassan,
Ramkumar Satish,
Cheng Kevin,
Vasanthakumar Sheran A.,
Rashid Hashrul,
Barton Timothy,
Nasis Arthur,
Meredith Ian T.,
Moir Stuart,
Mottram Philip M.
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12796
Subject(s) - medicine , transplantation , cardiology , population , heart failure , kidney disease , bruce protocol , stress echocardiography , stress testing (software) , metabolic equivalent , kidney transplantation , heart rate , blood pressure , physical therapy , coronary artery disease , physical activity , environmental health , computer science , programming language
Background Pharmacologic stress testing is utilized in preference to exercise stress echocardiography ( ESE ) for cardiac risk evaluation in potential renal transplant recipients due to the perceived lower feasibility of ESE for achieving adequate workload and target heart rate ( THR ) in this population. Methods Consecutive patients referred for cardiac risk evaluation prior to potential kidney transplantation were evaluated. All patients attempted ESE before pharmacologic testing was considered. Treadmill ESE utilized BRUCE protocol to maximum capacity. THR was defined as >85% of the maximum predicted heart rate (220‐age). Functional capacity was assessed by metabolic equivalents ( MET s) and the rate pressure product ( RPP ). Results Of 535 patients (349 male, age 56±11), 372(70%) reached THR . Mean MET s were 10±3 with 531(99%) achieving ≥4 MET s and 87% ≥7 MET s. Mean RPP was 25 821±5820 bpm×mm Hg (83% achieving >20 000 bpm×mm Hg). On multivariate analysis, independent predictors of failure to reach THR were rate‐control medication and diabetes; failure to reach 7 MET s: females, diabetics, age≥65, and previous cardiac disease; failure to reach RPP >20 000: rate‐control medication. There were 97% of ESE completed to physiologic endpoints. Conclusion In unselected potential renal transplant candidates, cardiac assessment by ESE is well tolerated, with 9‐in‐10 exercising to satisfactory functional capacity. ESE should be considered a feasible alternative to pharmacologic testing in this population.