Nicht invasive KHK-Diagnostik bei Niereninsuffizienz

Abstract

Cardiovascular diseases are the leading cause of death in patients with end-stage renal disease (ESRD). Thus, early identification of coronary artery disease by means of ischemia-testing and non-invasive imaging has the potential to reduce the cardiovascular disease associated morbidity and mortality. The presence of atherosclerotic plaques and increased intima-media-thickness within the extracranial arteries is a surrogate for the presence of coronary heart disease. Exercise ECG has a poor diagnostic accuracy and cannot be recommended for ischemia screening, in particular not for ESRD patients in whom already the resting ECG is pathologic. The different stress-imaging modalities (Echocardiography, magnetic-resonance imaging, MRI) have a high sensitivity and specificity in selected, suitable patients. However, advanced ESRD prohibits the use of Gadolinium contrast agents in MRI for viability assessment. Cardiac computer tomography (cCT) permits direct quantification of coronary calcification and is helpful for individual risk assessment. However, quantitative coronary angiography by cCT angiography requires administration of a radiographic contrast agent with an increased risk for contrast nephropathy, similar to the invasive coronary angiography approach.

• Literatur

• 1 Reinecke H, Brandenburg V, Dominiak P et al. Empfehlungen zur Diagnostik und Behandlung von Patienten mit koronarer Herzkrankheit und Niereninsuffizienz. Teil I: Pathophysiologie und Diagnostik. Clin Res Cardiol suppl 2006; 1: 8-30
• 2 Nakano T, Ninomiya T, Sumiyoshi S et al. Association of kidney function with coronary atherosclerosis and calcification in autopsy samples from japanese elders: The hisayama study. Am J kidney dis 2010; 55: 21-30
• 3 Erbel R, Mohlenkamp S, Jockel KH et al. Cardiovascular risk factors and signs of subclinical atherosclerosis in the heinz nixdorf recall study. Dtsch Arztebl international 2008; 105: 1-8
• 4 Lorenz MW, Polak JF, Kavousi M et al. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the prog-imt collaborative project): A meta-analysis of individual participant data. Lancet 2012; 379: 2053-2062
• 5 Greenland P, Alpert JS, Beller GA et al. accf/aha guideline for assessment of cardiovascular risk in asymptomatic adults: A report of the american college of cardiology foundation/american heart association task force on practice guidelines. Circulation 2010; 122: e584-e636
• 6 Modi N, Kapoor A, Kumar S et al. Utility of carotid intimal medial thickness as a screening tool for evaluation of coronary artery disease in pre-transplant end stage renal disease. J postgrad med 2006; 52: 266-270
• 7 Sharma R, Pellerin D, Gaze DC et al. Dobutamine stress echocardiography and the resting but not exercise electrocardiograph predict severe coronary artery disease in renal transplant candidates. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association – Eur Renal Association 2005; 20: 2207-2214
• 8 Elhendy A, van Domburg RT, Bax JJ et al. Significance of resting wall motion abnormalities in 2-dimensional echocardiography in patients without previous myocardial infarction referred for pharmacologic stress testing. J Am Soc Echocardiography 2000; 13: 1-8
• 9 Sicari R, Nihoyannopoulos P, Evangelista A et al. Stress echocardiography expert consensus statement – executive summary: European association of echocardiography (eae) (a registered branch of the esc). Eur Heart J 2009; 30: 278-289
• 10 Tita C, Karthikeyan V, Stroe A et al. Stress echocardiography for risk stratification in patients with end-stage renal disease undergoing renal transplantation. J Am Soc Echocardiography 2008; 21: 321-326
• 11 Taylor AJ, Cerqueira M, Hodgson JM et al. Accf/scct/acr/aha/ase/asnc/nasci/scai/scmr 2010 appropriate use criteria for cardiac computed tomography. Circulation 2010; 122: e525-e555
• 12 Schietinger BJ, Brammer GM, Wang H et al. Patterns of late gadolinium enhancement in chronic hemodialysis patients. JACC. Cardiovascular imaging 2008; 1: 450-456
• 13 Thomsen HS, Morcos SK, Almen T et al. Nephrogenic systemic fibrosis and gadolinium-based contrast media: Updated esur contrast medium safety committee guidelines. European radiology 2012;
• 14 Liu X, Zhao X, Huang J et al. Comparison of 3d free-breathing coronary mr angiography and 64-mdct angiography for detection of coronary stenosis in patients with high calcium scores. AJR Am J Roentgenol 2007; 189: 1326-1332
• 15 Patel RK, Mark PB, Johnston N et al. Prognostic value of cardiovascular screening in potential renal transplant recipients: A single-center prospective observational study. Am J transplantation 2008; 8: 1673-1683