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NDT Advance Access originally published online on November 14, 2007
Nephrology Dialysis Transplantation 2008 23(2):601-607; doi:10.1093/ndt/gfm642
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Prognostic significance of renal function in patients undergoing dobutamine stress echocardiography

Stefanos E. Karagiannis1, Harm H.H. Feringa1, Abdou Elhendy2, Ron van Domburg1, Michel Chonchol3, Radosav Vidakovic1, Jeroen J. Bax4, George Karatasakis5, George Athanasopoulos5, Dennis V. Cokkinos5 and Don Poldermans1

1Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands, 2Department of Cardiology, Marshfield Clinic, Marshfield, WI, USA, 3Division of Renal Diseases and Hypertension, University of Colorado, Health Sciences Center, Denver, CO, USA, 4Department of Cardiology, Leiden University, Leiden, The Netherlands and 5First Department of Cardiology, Onassis Cardiac Surgery Centre, Athens, Greece

Correspondence and offprint requests to: Don Poldermans, Department of Cardiology, Room H 923, Erasmus MC, 3015 GD Rotterdam, The Netherlands. Tel: +31-104639222; Fax: +31-104634957; E-mail: d.poldermans{at}erasmusmc.nl



  Abstract

Background. Dobutamine stress echocardiography (DSE) is used for risk stratification of patients with suspected coronary artery disease (CAD). However, the prognostic value of DSE among the entire strata of renal function has yet to be determined. We assessed the prognostic value of renal function relative to DSE findings.

Methods. We studied 2292 patients, divided into 729 (32%) patients with normal renal function [creatinine clearance (CrCl) >90 ml/min] and 1563 (68%) with renal dysfunction, classified as mild (CrCl: 60–90 ml/min) in 933, moderate (CrCl: 30–60 ml/min) in 502 and severe (CrCl < 30ml/min) in 128 patients. All patients underwent DSE for the evaluation of known or suspected CAD and were followed for a mean of 8 years.

Results. New wall motion abnormalities during DSE and mildly, moderately and severely abnormal CrCl were powerful independent predictors for all-cause mortality, cardiac death and hard cardiac events (cardiac death and non-fatal myocardial infarction). Kaplan–Meier curves demonstrated that patients with normal DSE and renal dysfunction have greater probability for cardiac death and hard cardiac events compared to those with normal renal function. The warranty of a normal DSE in the presence of moderate renal dysfunction was 15 and 36 months for 10 and 20% risk for cardiac death and hard cardiac events, respectively.

Conclusions. The presence and severity of renal dysfunction has additional independent prognostic value over DSE findings. The low-risk warrantee period after a normal DSE is determined by the severity of renal dysfunction.

Keywords: dobutamine stress echocardiography; prognosis; renal function

Received for publication: 20.12.06
Accepted in revised form: 22. 8.07


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