Prognostic value of dobutamine stress echocardiography for the long-term outcomes in kidney transplant candidates.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular diagnosis and therapy Pub Date : 2024-10-31 Epub Date: 2024-09-23 DOI:10.21037/cdt-24-174

Chanasnan Phawanawichian, Yodying Kaolawanich, Peenida Skulratanasak, Nithima Ratanasit

{"title":"Prognostic value of dobutamine stress echocardiography for the long-term outcomes in kidney transplant candidates.","authors":"Chanasnan Phawanawichian, Yodying Kaolawanich, Peenida Skulratanasak, Nithima Ratanasit","doi":"10.21037/cdt-24-174","DOIUrl":null,"url":null,"abstract":"Background: Cardiovascular disease is a primary cause of morbidity and mortality in kidney transplant (KT) candidates. Dobutamine stress echocardiography (DSE) is an effective noninvasive modality for evaluating coronary artery disease with high accuracy. However, long-term data in KT candidates are still lacking. This study aims to assess the prognostic value of DSE in predicting long-term outcomes in KT candidates.Methods: This study retrospectively included consecutive KT candidates who underwent preoperative DSE between 2007 and 2017 at Siriraj Hospital, Bangkok, Thailand. Normal DSE was characterized by the absence of wall motion abnormalities both at rest and during stress. The primary endpoint was all-cause mortality. Univariable and multivariable analyses were conducted to determine predictors of all-cause mortality, with a P value of <0.05 considered statistically significant.Results: Among 269 patients (mean age 51 years, 58% male), 34 (12.6%) had abnormal DSE results, and 63 (23%) underwent kidney transplantation after DSE. During a median follow-up period of 7.6 (4.5, 10.1) years, 129 (48%) patients died. Patients with abnormal DSE had a significantly higher mortality rate than those with normal DSE (73.5% vs. 44.2%, P=0.003). Univariable analysis demonstrated that male gender [hazard ratio (HR) 1.50, 95% confidence interval (CI): 1.04-2.16, P=0.03], resting systolic blood pressure (HR 1.006, 95% CI: 1.00-1.01, P=0.04), abnormal DSE (HR 1.95, 95% CI: 1.25-3.05, P=0.003), higher delta wall motion score index (HR 2.57, 95% CI: 1.24-5.35, P=0.01), abnormal stress left ventricular end-systolic volume (HR 2.05, 95% CI: 1.11-3.82, P=0.02), and post-KT status (HR 0.48, 95% CI: 0.30-0.79, P=0.004) were associated with mortality. In the multivariable analysis, male gender and abnormal DSE were independent predictors of mortality [adjusted HR (aHR) 1.65, 95% CI: 1.06-2.20, P=0.02 and aHR 1.88, 95% CI: 1.20-2.93, P=0.006, respectively], while post-KT status emerged as an independent predictor of better outcomes (aHR 0.47, 95% CI: 0.29-0.77, P=0.003).Conclusions: In KT candidates, preoperative assessment with DSE provides valuable prognostic information for long-term outcomes, particularly regarding all-cause mortality.","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"14 5","pages":"899-910"},"PeriodicalIF":2.1000,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538833/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular diagnosis and therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/cdt-24-174","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/23 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Cardiovascular disease is a primary cause of morbidity and mortality in kidney transplant (KT) candidates. Dobutamine stress echocardiography (DSE) is an effective noninvasive modality for evaluating coronary artery disease with high accuracy. However, long-term data in KT candidates are still lacking. This study aims to assess the prognostic value of DSE in predicting long-term outcomes in KT candidates.

Methods: This study retrospectively included consecutive KT candidates who underwent preoperative DSE between 2007 and 2017 at Siriraj Hospital, Bangkok, Thailand. Normal DSE was characterized by the absence of wall motion abnormalities both at rest and during stress. The primary endpoint was all-cause mortality. Univariable and multivariable analyses were conducted to determine predictors of all-cause mortality, with a P value of <0.05 considered statistically significant.

Results: Among 269 patients (mean age 51 years, 58% male), 34 (12.6%) had abnormal DSE results, and 63 (23%) underwent kidney transplantation after DSE. During a median follow-up period of 7.6 (4.5, 10.1) years, 129 (48%) patients died. Patients with abnormal DSE had a significantly higher mortality rate than those with normal DSE (73.5% vs. 44.2%, P=0.003). Univariable analysis demonstrated that male gender [hazard ratio (HR) 1.50, 95% confidence interval (CI): 1.04-2.16, P=0.03], resting systolic blood pressure (HR 1.006, 95% CI: 1.00-1.01, P=0.04), abnormal DSE (HR 1.95, 95% CI: 1.25-3.05, P=0.003), higher delta wall motion score index (HR 2.57, 95% CI: 1.24-5.35, P=0.01), abnormal stress left ventricular end-systolic volume (HR 2.05, 95% CI: 1.11-3.82, P=0.02), and post-KT status (HR 0.48, 95% CI: 0.30-0.79, P=0.004) were associated with mortality. In the multivariable analysis, male gender and abnormal DSE were independent predictors of mortality [adjusted HR (aHR) 1.65, 95% CI: 1.06-2.20, P=0.02 and aHR 1.88, 95% CI: 1.20-2.93, P=0.006, respectively], while post-KT status emerged as an independent predictor of better outcomes (aHR 0.47, 95% CI: 0.29-0.77, P=0.003).

Conclusions: In KT candidates, preoperative assessment with DSE provides valuable prognostic information for long-term outcomes, particularly regarding all-cause mortality.

查看原文本刊更多论文

多巴酚丁胺应激超声心动图对肾移植候选者长期预后的预测价值。

背景：心血管疾病是肾移植（KT）候选者发病和死亡的主要原因。多巴酚丁胺负荷超声心动图（DSE）是评估冠状动脉疾病的一种有效的无创方法，准确性很高。然而，KT 候选人的长期数据仍然缺乏。本研究旨在评估 DSE 在预测 KT 患者长期预后方面的预后价值：本研究回顾性纳入了 2007 年至 2017 年期间在泰国曼谷 Siriraj 医院接受术前 DSE 的连续 KT 候选人。正常 DSE 的特征是在静息和应力时均无室壁运动异常。主要终点是全因死亡率。进行了单变量和多变量分析，以确定全因死亡率的预测因素，P 值为结果：在 269 名患者（平均年龄 51 岁，58% 为男性）中，34 人（12.6%）的 DSE 结果异常，63 人（23%）在 DSE 后接受了肾移植。在中位 7.6（4.5，10.1）年的随访期间，129 名（48%）患者死亡。DSE 异常患者的死亡率明显高于 DSE 正常患者（73.5% 对 44.2%，P=0.003）。单变量分析表明，男性[危险比（HR）1.50，95% 置信区间（CI）：1.04-2.16，P=0.03]、静息收缩压（HR 1.006，95% CI：1.00-1.01，P=0.04）、DSE 异常（HR 1.95，95% CI：1.25-3.05，P=0.003）、更高的delta室壁运动评分指数（HR 2.57，95% CI：1.24-5.35，P=0.01）、异常应激左室收缩末期容积（HR 2.05，95% CI：1.11-3.82，P=0.02）和KT后状态（HR 0.48，95% CI：0.30-0.79，P=0.004）与死亡率相关。在多变量分析中，男性性别和 DSE 异常是死亡率的独立预测因素[调整后 HR（aHR）分别为 1.65，95% CI：1.06-2.20，P=0.02 和 aHR 1.88，95% CI：1.20-2.93，P=0.006]，而 KT 后状态则是更好结果的独立预测因素（aHR 0.47，95% CI：0.29-0.77，P=0.003）：对于 KT 候选者，术前 DSE 评估为长期预后，尤其是全因死亡率提供了有价值的预后信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

4.20%

发文量

期刊介绍： The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.