Feasibility of exercise stress echocardiography for cardiac risk assessment in chronic kidney disease patients prior to renal transplantation

Nitesh Nerlekar, William Mulley, Hassan Rehmani, Satish Ramkumar, Kevin Cheng, Sheran A. Vasanthakumar, Hashrul N.Z. Rashid, Timothy Barton, Arthur Nasis, Ian T. Meredith, Stuart Moir, Philip M. Mottram

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Abstract

Background: Pharmacologic stress testing is utilized in preference to exercise stress echocardiography (ESE) for cardiac risk evaluation in potential renal transplant recipients due to the perceived lower feasibility of ESE for achieving adequate workload and target heart rate (THR) in this population. Methods: Consecutive patients referred for cardiac risk evaluation prior to potential kidney transplantation were evaluated. All patients attempted ESE before pharmacologic testing was considered. Treadmill ESE utilized BRUCE protocol to maximum capacity. THR was defined as >85% of the maximum predicted heart rate (220-age). Functional capacity was assessed by metabolic equivalents (METs) and the rate pressure product (RPP). Results: Of 535 patients (349 male, age 56±11), 372(70%) reached THR. Mean METs were 10±3 with 531(99%) achieving ≥4 METs and 87% ≥7 METs. Mean RPP was 25 821±5820 bpm×mm Hg (83% achieving >20 000 bpm×mm Hg). On multivariate analysis, independent predictors of failure to reach THR were rate-control medication and diabetes; failure to reach 7 METs: females, diabetics, age≥65, and previous cardiac disease; failure to reach RPP>20 000: rate-control medication. There were 97% of ESE completed to physiologic endpoints. Conclusion: In unselected potential renal transplant candidates, cardiac assessment by ESE is well tolerated, with 9-in-10 exercising to satisfactory functional capacity. ESE should be considered a feasible alternative to pharmacologic testing in this population.

Original languageEnglish
Pages (from-to)1209-1215
Number of pages7
JournalClinical Transplantation
Volume30
Issue number10
DOIs
Publication statusPublished - 1 Oct 2016

Keywords

  • exercise testing
  • feasibility
  • renal transplant
  • stress echocardiography

Cite this

@article{54a1bb93fd714b92ad82182556e34f86,
title = "Feasibility of exercise stress echocardiography for cardiac risk assessment in chronic kidney disease patients prior to renal transplantation",
abstract = "Background: Pharmacologic stress testing is utilized in preference to exercise stress echocardiography (ESE) for cardiac risk evaluation in potential renal transplant recipients due to the perceived lower feasibility of ESE for achieving adequate workload and target heart rate (THR) in this population. Methods: Consecutive patients referred for cardiac risk evaluation prior to potential kidney transplantation were evaluated. All patients attempted ESE before pharmacologic testing was considered. Treadmill ESE utilized BRUCE protocol to maximum capacity. THR was defined as >85{\%} of the maximum predicted heart rate (220-age). Functional capacity was assessed by metabolic equivalents (METs) and the rate pressure product (RPP). Results: Of 535 patients (349 male, age 56±11), 372(70{\%}) reached THR. Mean METs were 10±3 with 531(99{\%}) achieving ≥4 METs and 87{\%} ≥7 METs. Mean RPP was 25 821±5820 bpm×mm Hg (83{\%} achieving >20 000 bpm×mm Hg). On multivariate analysis, independent predictors of failure to reach THR were rate-control medication and diabetes; failure to reach 7 METs: females, diabetics, age≥65, and previous cardiac disease; failure to reach RPP>20 000: rate-control medication. There were 97{\%} of ESE completed to physiologic endpoints. Conclusion: In unselected potential renal transplant candidates, cardiac assessment by ESE is well tolerated, with 9-in-10 exercising to satisfactory functional capacity. ESE should be considered a feasible alternative to pharmacologic testing in this population.",
keywords = "exercise testing, feasibility, renal transplant, stress echocardiography",
author = "Nitesh Nerlekar and William Mulley and Hassan Rehmani and Satish Ramkumar and Kevin Cheng and Vasanthakumar, {Sheran A.} and Rashid, {Hashrul N.Z.} and Timothy Barton and Arthur Nasis and Meredith, {Ian T.} and Stuart Moir and Mottram, {Philip M.}",
year = "2016",
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doi = "10.1111/ctr.12796",
language = "English",
volume = "30",
pages = "1209--1215",
journal = "Clinical Transplantation",
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Feasibility of exercise stress echocardiography for cardiac risk assessment in chronic kidney disease patients prior to renal transplantation. / Nerlekar, Nitesh; Mulley, William; Rehmani, Hassan; Ramkumar, Satish; Cheng, Kevin; Vasanthakumar, Sheran A.; Rashid, Hashrul N.Z.; Barton, Timothy; Nasis, Arthur; Meredith, Ian T.; Moir, Stuart; Mottram, Philip M.

In: Clinical Transplantation, Vol. 30, No. 10, 01.10.2016, p. 1209-1215.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Feasibility of exercise stress echocardiography for cardiac risk assessment in chronic kidney disease patients prior to renal transplantation

AU - Nerlekar, Nitesh

AU - Mulley, William

AU - Rehmani, Hassan

AU - Ramkumar, Satish

AU - Cheng, Kevin

AU - Vasanthakumar, Sheran A.

AU - Rashid, Hashrul N.Z.

AU - Barton, Timothy

AU - Nasis, Arthur

AU - Meredith, Ian T.

AU - Moir, Stuart

AU - Mottram, Philip M.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: Pharmacologic stress testing is utilized in preference to exercise stress echocardiography (ESE) for cardiac risk evaluation in potential renal transplant recipients due to the perceived lower feasibility of ESE for achieving adequate workload and target heart rate (THR) in this population. Methods: Consecutive patients referred for cardiac risk evaluation prior to potential kidney transplantation were evaluated. All patients attempted ESE before pharmacologic testing was considered. Treadmill ESE utilized BRUCE protocol to maximum capacity. THR was defined as >85% of the maximum predicted heart rate (220-age). Functional capacity was assessed by metabolic equivalents (METs) and the rate pressure product (RPP). Results: Of 535 patients (349 male, age 56±11), 372(70%) reached THR. Mean METs were 10±3 with 531(99%) achieving ≥4 METs and 87% ≥7 METs. Mean RPP was 25 821±5820 bpm×mm Hg (83% achieving >20 000 bpm×mm Hg). On multivariate analysis, independent predictors of failure to reach THR were rate-control medication and diabetes; failure to reach 7 METs: females, diabetics, age≥65, and previous cardiac disease; failure to reach RPP>20 000: rate-control medication. There were 97% of ESE completed to physiologic endpoints. Conclusion: In unselected potential renal transplant candidates, cardiac assessment by ESE is well tolerated, with 9-in-10 exercising to satisfactory functional capacity. ESE should be considered a feasible alternative to pharmacologic testing in this population.

AB - Background: Pharmacologic stress testing is utilized in preference to exercise stress echocardiography (ESE) for cardiac risk evaluation in potential renal transplant recipients due to the perceived lower feasibility of ESE for achieving adequate workload and target heart rate (THR) in this population. Methods: Consecutive patients referred for cardiac risk evaluation prior to potential kidney transplantation were evaluated. All patients attempted ESE before pharmacologic testing was considered. Treadmill ESE utilized BRUCE protocol to maximum capacity. THR was defined as >85% of the maximum predicted heart rate (220-age). Functional capacity was assessed by metabolic equivalents (METs) and the rate pressure product (RPP). Results: Of 535 patients (349 male, age 56±11), 372(70%) reached THR. Mean METs were 10±3 with 531(99%) achieving ≥4 METs and 87% ≥7 METs. Mean RPP was 25 821±5820 bpm×mm Hg (83% achieving >20 000 bpm×mm Hg). On multivariate analysis, independent predictors of failure to reach THR were rate-control medication and diabetes; failure to reach 7 METs: females, diabetics, age≥65, and previous cardiac disease; failure to reach RPP>20 000: rate-control medication. There were 97% of ESE completed to physiologic endpoints. Conclusion: In unselected potential renal transplant candidates, cardiac assessment by ESE is well tolerated, with 9-in-10 exercising to satisfactory functional capacity. ESE should be considered a feasible alternative to pharmacologic testing in this population.

KW - exercise testing

KW - feasibility

KW - renal transplant

KW - stress echocardiography

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U2 - 10.1111/ctr.12796

DO - 10.1111/ctr.12796

M3 - Article

VL - 30

SP - 1209

EP - 1215

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 10

ER -