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.
