DSE may perform better than MPS but additional studies directly comparing these cardiac screening tests are needed. Absence of significant CAD may not necessarily correlate with cardiac-event free survival following transplantation. Further research should focus on assessing the ability of functional tests to predict postoperative outcome.
Use of digital subtraction fluorography in screening for coronary artery disease in patients with chronic renal failure.
The diagnosis of coronary artery disease remains a major problem in patients with end-stage renal disease. Screening with conventional noninvasive techniques is limited by the poor exercise capacity of these patients. This study evaluated the accuracy of digital subtraction fluorography in detecting coronary calcification as a noninvasive, nonexercise screening test for coronary artery disease. Eighty-six patients under evaluation for renal transplantation and considered at increased risk of coronary artery disease were studied by coronary arteriography and digital subtraction fluorography for coronary calcification. Significant coronary disease (greater than or equal to 50% obstruction in at least one vessel) was present in 36 (42%) patients. The detection of coronary calcification by digital subtraction fluorography had a sensitivity of 78% and a specificity of 66%. The probability of disease being present in the absence of coronary calcification in this group was 18%. The detection of coronary calcification by digital subtraction fluorography appears to be a satisfactory and inexpensive screening test in this setting.