Stress echocardiography for risk stratification in patients with end-stage renal disease undergoing renal transplantation

Background: The predictive accuracy of stress echocardiography ( SE) for adverse cardiac events has been variable in the population with end- stage renal disease undergoing renal transplantation ( RT). Methods: We performed a retrospective study of 149 patients who had pretransplant SE before RT between 1997 and 2003. Patients were followed up for a mean of 2.85 years for major adverse cardiovascular events ( MACE). Results: Of 149 patients studied, 139 had a negative SE, 65% were African American; 12 underwent cardiac catheterization. Only 1 patient required pre-RT revascularization. Sixteen MACE occurred over the follow-up period. SE had 37.5% sensitivity, 95.3% specificity, 33.3% positive predictive value, and 96.1% negative predictive value for MACE in the first year post-RT. First-year posttransplant event rates were 4.0% versus 30% ( P < .001) for patients with a negative SE and positive SE, respectively. Multivariate predictors of MACE were positive SE ( hazard ratio [ HR] 7.64), hemoglobin less than 11 g/ dL post- RT ( HR 4.44), and calcium channel blocker use posttransplant ( HR 2.90). Conclusions: A negative SE has low incidence of MACE in this intermediate- to high-risk patient subset. A positive SE predicts a sevenfold higher risk of cardiovascular events regardless of the need for revascularization before the transplant.