Should we do cardiac stress tests in asymptomatic renal transplant candidates?

Background: There is controversy regarding the best method and benefit of cardiac evaluation of asymptomatic renal transplant candidates. The positive predictive value of ischemia on a noninvasive stress test was ∼5%-10% in Kidney Disease Outcomes Quality Initative (KDOQI), American Society of Transplantation (AST), and Lisbon guidelines. We compared prediction of cardiac events with the use of simple transthoracic echocardiography versus a noninvasive stress test in asymptomatic candidates.

Methods: We selected asymptomatic patients with good functional capacity who would be recommended a cardiac stress test by both KDOQI and AST guidelines, we excluding those with a history of cardiovascular disease. Group A (n = 124) underwent only echocardiography, and group B (n = 41) underwent echocardiography and noninvasive stress test. We measured the incidences of cardiac events and cardiac death within 3 years after transplantation.

Results: The mean age of group A was 39 ± 7 and group B 40 ± 5 years. Diabetic patients among groups A and B were 8.8% (11/124) and 9.7% (4/41), respectively. The mean duration of dialysis was 2.9 ± 5 years. Only 4 group B patients showed a positive result on the noninvasive stress test, but they had no obstructive disease on coronary angiograms. The incidences of ischemic heart disease after transplantation of groups A and B were 4% (5/124) and 4.8% (2/41), respectively (P = .88). There was no death due to cardiac events in either group.

Conclusions: In this study, simple echocardiography showed an ability similar to stress test to predict ischemic heart disease in asymptomatic renal transplant candidates with good functional capacity, relatively younger age, lower prevalence of diabetes, and shorter duration of dialysis.