Abstract: TH-PO1138
Exercise Stress Electrocardiogram for Pretransplant Cardiac Evaluation: A Costly but Generally Useless Effort
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Watschinger, Bruno, Medical University of Vienna, Vienna, Austria
- Scherr, Stefan, Medical University of Vienna, Vienna, Austria
- Meyer, Elias Laurin, Medical University of Vienna, Vienna, Austria
- Hohenstein-Scheibenecker, Katharina, Medical University of Vienna, Vienna, Austria
Background
There is an ongoing debate on the informative values of cardiac evaluation tests in renal transplant candidates. Exercise stress electrocardiogram (ES-ECG) is advocated and widely used as a non-invasive test to rule out significant coronary artery disease before renal transplantation. The precondition of a test sufficient for interpretation is the achievement of an age adjusted maximal work capacity. We were interested in the fundamental question, whether the test yields meaningful results in transplant candidates at all and how achieved exercise capacities compare to healthy individuals.
Methods
Of 1319 dialysis patients transplanted at our institution (between 29/02/2000 and 30/09/2017) 453 (mean age 51,2+/-12,6 yrs) underwent cycle-ergometer ES-ECG testing during their pre-transplant work-up. 137 kidney donors (mean age 50,4+/-9,8 yrs), who were also evaluated by ES-ECG served as control group. We evaluated two endpoints related to the tests meaningfulness and sufficiency: 1) whether study subjects reached maximal work capacity (according to exercise resistance level, measured in Watts or expected heart rate (HR) reached) and 2) whether patients had sufficiently diagnostic test results (i.e. achievement of the maximal work capacity (Watt) or the expected HR or experienced symptoms at lower work intensities. In order to assess test result sufficiency of transplant candidates and kidney donors, absolute and relative frequencies plus 95% CIs for both endpoints were computed and compared by a two-sided two proportion z-Test.
Results
see Table
Conclusion
While maximum exercise capacity (measured in Watt) was achieved by 82 % of healthy kidney donors only a minority of dialysis patients was fit enough to adequately perform during ES-ECG. Consequently meaningful results during ES-ECG were observed in only 37 % of dialysis patients, making Exercise stress electrocardiogram a generally useless, but with regard to time and resources costly effort in the cardiac evaluation of renal transplant candidates.
| Transplant candidates | Kidney donors | P-Value | |
| Maximal work capacity reached | 0.32 [0.30;0.34] (144/453) | 0.82 [0.79;0.85] (112/137) | <0.0001* |
| Test sufficiently diagnostic | 0.37 [0.35;0.39] (166/453) | 0.82 [0.79;0.85] (112/137) | <0.0001* |
* P-values are based on the two-sided two proportion z-Test