Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging

Lukas D Weberling; Sebastian Seitz; Janek Salatzki; Andreas Ochs; Ailís C Haney; Deborah Siry; Jannick Heins; Henning Steen; Norbert Frey; Florian André

doi:10.3389/fcvm.2023.1228691

Safety, accuracy, and prediction of prognosis in patients with end-stage chronic kidney disease undergoing dobutamine stress cardiac magnetic resonance imaging

Front Cardiovasc Med. 2023 Aug 30:10:1228691. doi: 10.3389/fcvm.2023.1228691. eCollection 2023.

Authors

Lukas D Weberling^{1

2}, Sebastian Seitz^{1

3}, Janek Salatzki^{1

2}, Andreas Ochs^{1

2}, Ailís C Haney¹, Deborah Siry¹, Jannick Heins¹, Henning Steen^{1

4}, Norbert Frey^{1

2}, Florian André^{1

2}

Affiliations

¹ Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.
² DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Germany.
³ MVZ-DRZ Heidelberg, Heidelberg, Germany.
⁴ Medneo, Hamburg, Germany.

Abstract

Introduction: Advanced chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Due to its unique uremia-derived pathophysiology of atherosclerosis and the limitations of using potentially harmful contrast agents, the best non-invasive approach to assess CAD in these patients remains unclear. We sought to investigate the accuracy, safety, and prognosis of patients with severe CKD undergoing dobutamine stress cardiac magnetic resonance imaging (CMR).

Materials and methods: In this retrospective, single-center study, patients on dialysis or with a glomerular filtration rate of <15 ml/min/1.73 m² who underwent dobutamine stress CMR were included. A rest and stress wall motion analysis was performed using dobutamine/atropine as stressor. The target heart rate was 85% of the maximum heart rate. Periprocedural adverse events and 1-year follow-up data were obtained.

Results: A total of 176 patients (127 men, 49 women) with a mean age of 60.9 ± 14.7 years were included, of which 156 patients were on permanent dialysis. Short-term symptoms such as angina or shortness of breath during stress CMR were frequent (22.1%), but major complications were rare (one patient with myocardial infarction, 0.6%). The 1-year event rate was high (16.4%) with a significant independent correlation to reduced ejection fraction at rest (p = 0.037) and failure to achieve the target heart rate (p = 0.029). The overall accuracy for predicting significant CAD was good (sensitivity of 71.4%, specificity of 98.4%) and excellent if the target heart rate was achieved (83.3%, 97.9%). A negative stress CMR was highly predictive for the absence of major adverse cardiac event or any coronary revascularization during the 1-year follow-up (negative predictive value of 95.0%).

Discussion: Dobutamine stress CMR is a safe and accurate diagnostic imaging technique in patients at advanced stages of chronic kidney disease. A reduced ejection fraction and the inability to reach the target heart rate are independent predictors of a poor outcome.

Keywords: CAD; CMR; cardiovascular imaging; chronic kidney disease; dialysis; dobutamine.

Grants and funding

LW was supported by the Rotation Grand (D.10021788) of the DZHK (German Centre for Cardiovascular Research). The DZHK did not have any influence on the design, analysis, or interpretation of the study. For the publication fee we acknowledge financial support by Deutsche Forschungsgemeinschaft within the funding programme “Open Access Publikationskosten” as well as by Heidelberg University.