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Abstract: TH-PO1138

Exercise Stress Electrocardiogram for Pretransplant Cardiac Evaluation: A Costly but Generally Useless Effort

Session Information

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 candidatesKidney donorsP-Value
Maximal work capacity reached0.32 [0.30;0.34] (144/453)0.82 [0.79;0.85] (112/137)<0.0001*
Test sufficiently diagnostic0.37 [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