Cardiac testing for coronary artery disease in potential kidney transplant recipients: A systematic review of test accuracy studies

Wang, LW; Fahim, MA; Hayen, A; Mitchell, RL; Lord, SW; Baines, LA; Craig, JC; Webster, AC

Cardiac testing for coronary artery disease in potential kidney transplant recipients: A systematic review of test accuracy studies

Wang, LW Fahim, MA Hayen, A

Mitchell, RL Lord, SW Baines, LA Craig, JC Webster, AC

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Publication Type:: Journal Article
Citation:: American Journal of Kidney Diseases, 2011, 57 (3), pp. 476 - 487
Issue Date:: 2011-03-01

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Field	Value	Language
dc.contributor.author	Wang, LW	en_US
dc.contributor.author	Fahim, MA	en_US
dc.contributor.author	Hayen, A https://orcid.org/0000-0003-4046-8030	en_US
dc.contributor.author	Mitchell, RL	en_US
dc.contributor.author	Lord, SW	en_US
dc.contributor.author	Baines, LA	en_US
dc.contributor.author	Craig, JC	en_US
dc.contributor.author	Webster, AC	en_US
dc.date.available	2010-11-08	en_US
dc.date.issued	2011-03-01	en_US
dc.identifier.citation	American Journal of Kidney Diseases, 2011, 57 (3), pp. 476 - 487	en_US
dc.identifier.issn	0272-6386	en_US
dc.identifier.uri	http://hdl.handle.net/10453/116412
dc.description.abstract	Background: Cardiovascular disease is the leading cause of death after kidney transplant. Screening for coronary artery disease is integral to pretransplant evaluation, although the relative performance of different tests is uncertain. Study Design: Systematic review of diagnostic test accuracy studies using hierarchical summary receiver operating characteristic analysis. Setting & Population: Kidney transplant candidates undergoing pretransplant assessment. Selection Criteria of Studies: Studies evaluating the accuracy of screening tests for detecting coronary artery disease. Index Tests: Any non- or minimally invasive test used to diagnose coronary artery disease. Reference Test: Coronary angiography. Results: 11 studies (690 participants) evaluated dobutamine stress echocardiography; 7 (317 participants), myocardial perfusion scintigraphy; 2 (129 participants), exercise stress electrocardiography; and 2 (121 participants), other tests. Dobutamine stress echocardiography had pooled sensitivity of 0.80 (95% CI, 0.64-0.90) and specificity of 0.89 (95% CI, 0.79-0.94). Myocardial perfusion scintigraphy had pooled sensitivity of 0.69 (95% CI, 0.48-0.85) and specificity of 0.77 (95% CI, 0.59-0.89). Head-to-head comparison of dobutamine stress echocardiography and myocardial perfusion scintigraphy (2 studies; 116 participants) showed that dobutamine stress echocardiography had higher specificity and at least equivalent or higher sensitivity. Indirect comparison suggested dobutamine stress echocardiography may have improved accuracy over myocardial perfusion scintigraphy (P = 0.07). Limitations: Power to detect differences in accuracy between tests is limited due to sparse data. Absence of significant coronary artery disease may not necessarily correlate with cardiac event-free survival after transplant. Conclusions: Dobutamine stress echocardiography may perform better than myocardial perfusion scintigraphy; however, additional studies directly comparing dobutamine stress echocardiography and myocardial perfusion scintigraphy are needed. Further research should focus on assessing the ability of functional tests to predict postoperative outcome. © 2011 National Kidney Foundation, Inc.	en_US
dc.relation.ispartof	American Journal of Kidney Diseases	en_US
dc.relation.isbasedon	10.1053/j.ajkd.2010.11.018	en_US
dc.subject.classification	Urology & Nephrology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Kidney Failure, Chronic	en_US
dc.subject.mesh	Heart Function Tests	en_US
dc.subject.mesh	Kidney Transplantation	en_US
dc.subject.mesh	Reproducibility of Results	en_US
dc.subject.mesh	Coronary Artery Disease	en_US
dc.title	Cardiac testing for coronary artery disease in potential kidney transplant recipients: A systematic review of test accuracy studies	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	57	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	110312 Nephrology and Urology	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	57	en_US

Abstract:

Background: Cardiovascular disease is the leading cause of death after kidney transplant. Screening for coronary artery disease is integral to pretransplant evaluation, although the relative performance of different tests is uncertain. Study Design: Systematic review of diagnostic test accuracy studies using hierarchical summary receiver operating characteristic analysis. Setting & Population: Kidney transplant candidates undergoing pretransplant assessment. Selection Criteria of Studies: Studies evaluating the accuracy of screening tests for detecting coronary artery disease. Index Tests: Any non- or minimally invasive test used to diagnose coronary artery disease. Reference Test: Coronary angiography. Results: 11 studies (690 participants) evaluated dobutamine stress echocardiography; 7 (317 participants), myocardial perfusion scintigraphy; 2 (129 participants), exercise stress electrocardiography; and 2 (121 participants), other tests. Dobutamine stress echocardiography had pooled sensitivity of 0.80 (95% CI, 0.64-0.90) and specificity of 0.89 (95% CI, 0.79-0.94). Myocardial perfusion scintigraphy had pooled sensitivity of 0.69 (95% CI, 0.48-0.85) and specificity of 0.77 (95% CI, 0.59-0.89). Head-to-head comparison of dobutamine stress echocardiography and myocardial perfusion scintigraphy (2 studies; 116 participants) showed that dobutamine stress echocardiography had higher specificity and at least equivalent or higher sensitivity. Indirect comparison suggested dobutamine stress echocardiography may have improved accuracy over myocardial perfusion scintigraphy (P = 0.07). Limitations: Power to detect differences in accuracy between tests is limited due to sparse data. Absence of significant coronary artery disease may not necessarily correlate with cardiac event-free survival after transplant. Conclusions: Dobutamine stress echocardiography may perform better than myocardial perfusion scintigraphy; however, additional studies directly comparing dobutamine stress echocardiography and myocardial perfusion scintigraphy are needed. Further research should focus on assessing the ability of functional tests to predict postoperative outcome. © 2011 National Kidney Foundation, Inc.

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http://hdl.handle.net/10453/116412