Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging
IntroductionAdvanced chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Due to its unique uremia-derived pathophysiology of atherosclerosis and the limitations of using potentially harmful contrast agents, the best non-invasive approach to assess CAD in the...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1228691/full |
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| author | Lukas D. Weberling Lukas D. Weberling Sebastian Seitz Sebastian Seitz Janek Salatzki Janek Salatzki Andreas Ochs Andreas Ochs Ailís C. Haney Deborah Siry Jannick Heins Henning Steen Henning Steen Norbert Frey Norbert Frey Florian André Florian André |
| author_facet | Lukas D. Weberling Lukas D. Weberling Sebastian Seitz Sebastian Seitz Janek Salatzki Janek Salatzki Andreas Ochs Andreas Ochs Ailís C. Haney Deborah Siry Jannick Heins Henning Steen Henning Steen Norbert Frey Norbert Frey Florian André Florian André |
| author_sort | Lukas D. Weberling |
| collection | DOAJ |
| description | IntroductionAdvanced chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Due to its unique uremia-derived pathophysiology of atherosclerosis and the limitations of using potentially harmful contrast agents, the best non-invasive approach to assess CAD in these patients remains unclear. We sought to investigate the accuracy, safety, and prognosis of patients with severe CKD undergoing dobutamine stress cardiac magnetic resonance imaging (CMR).Materials and methodsIn this retrospective, single-center study, patients on dialysis or with a glomerular filtration rate of <15 ml/min/1.73 m2 who underwent dobutamine stress CMR were included. A rest and stress wall motion analysis was performed using dobutamine/atropine as stressor. The target heart rate was 85% of the maximum heart rate. Periprocedural adverse events and 1-year follow-up data were obtained.ResultsA total of 176 patients (127 men, 49 women) with a mean age of 60.9 ± 14.7 years were included, of which 156 patients were on permanent dialysis. Short-term symptoms such as angina or shortness of breath during stress CMR were frequent (22.1%), but major complications were rare (one patient with myocardial infarction, 0.6%). The 1-year event rate was high (16.4%) with a significant independent correlation to reduced ejection fraction at rest (p = 0.037) and failure to achieve the target heart rate (p = 0.029). The overall accuracy for predicting significant CAD was good (sensitivity of 71.4%, specificity of 98.4%) and excellent if the target heart rate was achieved (83.3%, 97.9%). A negative stress CMR was highly predictive for the absence of major adverse cardiac event or any coronary revascularization during the 1-year follow-up (negative predictive value of 95.0%).DiscussionDobutamine stress CMR is a safe and accurate diagnostic imaging technique in patients at advanced stages of chronic kidney disease. A reduced ejection fraction and the inability to reach the target heart rate are independent predictors of a poor outcome. |
| first_indexed | 2024-03-12T12:16:44Z |
| format | Article |
| id | doaj.art-7482e2be5a8041c3a8ef95fc90dee8b9 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-12T12:16:44Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-7482e2be5a8041c3a8ef95fc90dee8b92023-08-30T12:13:02ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-08-011010.3389/fcvm.2023.12286911228691Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imagingLukas D. Weberling0Lukas D. Weberling1Sebastian Seitz2Sebastian Seitz3Janek Salatzki4Janek Salatzki5Andreas Ochs6Andreas Ochs7Ailís C. Haney8Deborah Siry9Jannick Heins10Henning Steen11Henning Steen12Norbert Frey13Norbert Frey14Florian André15Florian André16Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyMVZ-DRZ Heidelberg, Heidelberg, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyMedneo, Hamburg, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, GermanyDepartment of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, GermanyDZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, GermanyIntroductionAdvanced chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Due to its unique uremia-derived pathophysiology of atherosclerosis and the limitations of using potentially harmful contrast agents, the best non-invasive approach to assess CAD in these patients remains unclear. We sought to investigate the accuracy, safety, and prognosis of patients with severe CKD undergoing dobutamine stress cardiac magnetic resonance imaging (CMR).Materials and methodsIn this retrospective, single-center study, patients on dialysis or with a glomerular filtration rate of <15 ml/min/1.73 m2 who underwent dobutamine stress CMR were included. A rest and stress wall motion analysis was performed using dobutamine/atropine as stressor. The target heart rate was 85% of the maximum heart rate. Periprocedural adverse events and 1-year follow-up data were obtained.ResultsA total of 176 patients (127 men, 49 women) with a mean age of 60.9 ± 14.7 years were included, of which 156 patients were on permanent dialysis. Short-term symptoms such as angina or shortness of breath during stress CMR were frequent (22.1%), but major complications were rare (one patient with myocardial infarction, 0.6%). The 1-year event rate was high (16.4%) with a significant independent correlation to reduced ejection fraction at rest (p = 0.037) and failure to achieve the target heart rate (p = 0.029). The overall accuracy for predicting significant CAD was good (sensitivity of 71.4%, specificity of 98.4%) and excellent if the target heart rate was achieved (83.3%, 97.9%). A negative stress CMR was highly predictive for the absence of major adverse cardiac event or any coronary revascularization during the 1-year follow-up (negative predictive value of 95.0%).DiscussionDobutamine stress CMR is a safe and accurate diagnostic imaging technique in patients at advanced stages of chronic kidney disease. A reduced ejection fraction and the inability to reach the target heart rate are independent predictors of a poor outcome.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1228691/fullCMRcardiovascular imagingCADdialysisdobutaminechronic kidney disease |
| spellingShingle | Lukas D. Weberling Lukas D. Weberling Sebastian Seitz Sebastian Seitz Janek Salatzki Janek Salatzki Andreas Ochs Andreas Ochs Ailís C. Haney Deborah Siry Jannick Heins Henning Steen Henning Steen Norbert Frey Norbert Frey Florian André Florian André Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging Frontiers in Cardiovascular Medicine CMR cardiovascular imaging CAD dialysis dobutamine chronic kidney disease |
| title | Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging |
| title_full | Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging |
| title_fullStr | Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging |
| title_full_unstemmed | Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging |
| title_short | Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging |
| title_sort | safety accuracy and prediction of prognosis in patients with end stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging |
| topic | CMR cardiovascular imaging CAD dialysis dobutamine chronic kidney disease |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1228691/full |
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