Prevalence of occult coronary artery disease in patients with renal insufficiency

Chronic renal insufficiency [CRI] is a predictor of stroke, cardiovascular, and all-cause mortality, but the mechanisms responsible for these associations are unclear. Whether CRI was associated with severity of coronary artery disease [CAD]. 230 patients with CRI were subjected to stress echocardiography to evaluate stable CAD. The correlations of various parameters with the prevalence of CAD were also examined. Atherosclerotic surrogate markers, including intima-media thickness of carotid artery and ankle-brachial BP index [ABI], were also evaluated. Renal function was assessed by 24-h urine collection, and CRI was defined as measured creatinine clearance 60 ml/min. Stress echocardiography was used to identify inducible ischemia, defined as any wall motion abnormality seen at stress but not at rest. Logistic regression was used to evaluate the association of CRI with exercise-induced ischemia after adjustment for cardiovascular risk factors. Among the 230 participants, 55 [23.9%] had CAD, and were characterized by older age, lower ejection fraction, greater left ventricular mass and higher C-reactive protein values. The prevalence of exercise-induced ischemia was also substantially greater in the participants with CRI distributed in such way that 20.1% in group I compared with 44.4% group II [odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4 to 3.8; p < 0.01]. After multivariate adjustment, CRI remained strongly associated with exercise-induced ischemia [OR, 2.0; 95% CI, 1.2 to 3.3; p = 0.01]. After further adjustment for CRP, the adjusted association was essentially unchanged [OR, 2.3; 95% CI, 1.0 to 5.1; p <0.05]. Univariate analysis showed that diabetes [p <0.01], left ventricular mass index [p<0.05], hyperlipidemia [p <0.01], total cholesterol [p <0.01], LDL cholesterol [p <0.01], and intima-media thickness [p < 0.01], were positively correlated with the presence of CAD, whereas ABI [p <0.01] showed a negative correlation with CAD. Stepwise logistic regression analysis revealed that diabetes was significant and independent risk factor for CAD in asymptomatic CRI patients. CRI is strongly associated with exercise-induced ischemia in patients with CAD. The greater severity of atherosclerotic disease observed in patients with CRI may in part explain the association of CRI with increased cardiovascular risk among individuals with CAD

Predictive value of myocardial acceleration during isovolumic contraction during dobutamine stress echocardiography: pulsed wave tissue doppler study

Tissue Doppler echocardiography [DTE] can improve the diagnostic accuracy of dobutamine stress echocardiography [DSE] for detection of coronary artery disease, myocardial acceleration during isovolumic contraction or isovolumic acceleration [IVA] derived from tissue Doppler echocardiography may predict significant coronary stenosis. Comparing the regional response IVA to dobutamine stress echocardiography to coronary angiographic findings. 30 patient with chest pain suggestive of coronary artery disease [CAD] subjected to dobutamine stress tissue Doppler echocardiography prior to coronary angiography. Patients were classified according to the angiographic findings into group I [20 patients] with significant CAD and group II [10 subjects] with normal coronaries. IVA was analyzed at rest and peak stress in 360 segments distributed according to the angiographic findings into 108 ischemic segments supplied by culprit coronary artery distal to the site of stenosis [group IA], 132 non ischemic segments supplied by non diseased part of the culprit vessel or by non affected vessel [group IB] and 120 normal segments from control subjects. The diagnostic accuracy of IVA to predict coronary stenosis was determined using cut-off values. Regional IVA increased in dose dependent manner during dobutamine infusion. The response was blunted in the ischemic segments where the magnitude of change in IVA from rest to peak was significantly lower in group IA compared to group IB and group II. Globally the magnitude of change in IVA also significantly lower in group I than in group II. Increased IVA velocity by