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Published on: February 10, 2013
Prognostic significance of renal function in patients undergoing dobutamine stress echocardiography
Stefanos E Karagiannis1, Harm H H Feringa, Abdou Elhendy
1Department of Cardiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
Insights
Renal dysfunction severity impacts cardiac event risk, even with normal dobutamine stress echocardiography (DSE) results. Patients with kidney issues face higher risks, shortening the safe period after a normal DSE test.
Area of Science:
- Cardiology
- Nephrology
- Diagnostic Imaging
Background:
- Dobutamine stress echocardiography (DSE) is a key tool for assessing coronary artery disease (CAD) risk.
- The impact of varying renal function on DSE prognostic accuracy remains unclear.
Purpose of the Study:
- To evaluate the prognostic value of renal function in patients undergoing DSE for suspected CAD.
- To determine if renal dysfunction independently predicts adverse cardiac events.
Main Methods:
- 2292 patients with suspected CAD underwent DSE.
- Patients were categorized by renal function based on creatinine clearance (CrCl): normal (>90 ml/min), mild (60-90 ml/min), moderate (30-60 ml/min), and severe (<30 ml/min).
- Long-term follow-up (mean 8 years) assessed all-cause mortality, cardiac death, and hard cardiac events.
Main Results:
- Both abnormal DSE findings and impaired renal function (mild, moderate, severe CrCl) independently predicted mortality and cardiac events.
- Patients with normal DSE but renal dysfunction had a higher risk of cardiac death and hard cardiac events compared to those with normal renal function.
- A normal DSE in moderate renal dysfunction offered a limited low-risk window (15-36 months) for cardiac death and hard cardiac events.
Conclusions:
- Renal dysfunction severity provides independent prognostic information beyond DSE findings.
- The prognostic implications of a normal DSE are significantly influenced by the degree of underlying renal dysfunction.
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 < 30 ml/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 warranty period after a normal DSE is determined by the severity of renal dysfunction.
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