Clinical Investigation
Imaging and Diagnostic Testing
Prognostic value of dobutamine stress echocardiography in patients with chronic kidney disease

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Background

Although dobutamine stress echocardiography (DSE) is cited in clinical guidelines for the evaluation of patients with chronic kidney disease (CKD), there are limited data regarding its prognostic utility in this setting. The current study assesses the prognostic value of DSE in patients with CKD.

Methods

Four hundred eighty-five patients with CKD (on renal dialysis or with creatinine >3 mg/mL) who had DSE were followed for 2.3 ± 1.8 years.

Results

One hundred eighty-eight (39%) patients died during follow-up. Patients with extensive ischemia (affecting >25% of myocardial segments) had a 1- and 3-year survival rate of 77% and 48%, respectively, compared with 83% and 52% in those with lesser degrees (≤25% segments affected) of ischemia and with 88% and 70% in those with a normal DSE. In multivariate analyses, the percentage of ischemic segments on DSE was an independent predictor of all-cause mortality (hazard ratio, 1.40 per 25% increase; 95% CI, 1.16-1.68; P = .001). Inclusion of DSE data improved the predictive value of the best clinical model (χ2, 83.6-97.4; P = .003).

Conclusion

In patients with CKD, the percentage of ischemic segments during DSE is an independent predictor of mortality and provides prognostic information that is incremental to clinical data.

Section snippets

Patients

The study was approved by the Institutional Review Board of the Mayo Clinic. From January 1990 to December 2000, 10 650 patients underwent a clinically indicated DSE at our institution. Of those, we identified 485 patients with CKD at the time of the DSE. This was defined by the following criteria: (1) baseline creatinine level >3 mg/dL and/or (2) the requirement for renal replacement therapy (in the form of hemodialysis or peritoneal dialysis).

Cardiovascular risk factors were recorded.

Study group

The study population included 485 patients. Of these, 245 (51%) patients had a creatinine >3 mg/dL at enrollment and 240 (49%) patients were on dialysis. The mean age was 61 ± 14 years, and 298 (61%) of the patients were male (Table I). The etiology of renal disease was diabetes mellitus in 184 (38%), renovascular in 39 (8%), hypertension in 37 (8%), glomerulonephritis in 36 (7%), polycystic kidney disease in 30 (6%), and other or unknown in 159 (33%) patients. Thirteen patients (3%) had

Discussion

Patients with CKD but with normal DSE had a better prognosis compared with those with an abnormal study. Indeed, 70% of these patients were alive 3 years later compared with 52% of patients with mild to moderate and 48% of patients with extensive ischemia. The percentage of ischemic segments at DSE was a powerful and independent predictor of mortality. After adjustment for other predictors, every 25% increase in ischemic segments was associated with a 37% increase in the instantaneous risk of

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    • Cited by (0)

    Dr Bergeron was supported by a grant from Laval University, Quebec, Canada, and Dr Hillis by a grant from the British Heart Foundation. The study was supported by a grant from the Mayo Foundation.

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    These authors contributed equally to this work.

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