Brennan 1997.

Clinical features and settings	Clinical features Patients with ESKD at risk of CAD who presented for kidney transplant cardiac evaluation Setting Washington University and Barnes‐Jewish Hospital, St. Louis, Missouri, USA
Participants	Number: 47 DM: 56% Hypertension: 90% Sex: 45% male Mean age: 51 years History of smoking: 61% Hypercholesterolaemia: 15% Coronary heart failure: 2% Clinical evidence CAD: 21%
Study design	Cohort study
Target condition and reference standard(s)	Coronary artery stenosis measured by coronary angiography The criterion for positive test results was ≥ 50% reduction in cross sectional area.
Index and comparator tests	DSE Two‐dimensional echocardiography as part of pretransplant evaluation. Graded infusions of dobutamine were administered (5 to 40 mg/kg/min) until the maximum predicted heart rate was achieved. If needed, IV atropine (0.4 to 2.0 mg) was given to increase heart rate to ˜85% of the maximum predicted heart rate. The test was terminated if patients developed: significant arrhythmia, severe hypertension or hypotension, or had new or worsening baseline segmental wall motion abnormalities in ≥ 2 major coronary perfusion regions. Segmental wall motion was scored according to American Society of Echocardiography recommendations, using lh‐segment model. Each segment was graded using a semi‐quantitative scoring system (normal or hyperdynamic (1); hypokinesis (2); akinesis (3); dyskinesis (4)). The wall motion score index was derived as an average of the 16 segments. All studies were reviewed independently by 2 experienced echocardiographers who were blinded to the clinical data.
Follow‐up	Follow‐up (range 3 to 64 months) data were obtained for all 47 participants.
Notes	Of the 47 patients who underwent DSE, all 5 patients who tested positive received coronary angiography. Seven other patients who had negative DSE received coronary angiography. The decision about providing coronary angiography for those who were index test negative was not made on grounds of clinical or high pre‐test suspicion (author correspondence).
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Yes	Patients with ESKD at risk of CAD who presented for kidney transplant cardiac evaluation.
Acceptable reference standard? All tests	Yes	Coronary angiography with a reference standard threshold of ≥ 50% stenosis.
Acceptable delay between tests? All tests	Yes	Average time from DSE to coronary angiography < 9 months (author correspondence).
Partial verification avoided? All tests	No	Of the 47 patients who underwent DSE, 5 who tested positive underwent coronary angiography, and 7 others who had negative DSE results also underwent coronary angiography. The reason that patients who were index test negative underwent coronary angiography was for other than clinical or high pre‐test suspicion (author correspondence)
Differential verification avoided? All tests	Yes	Disease status (CAD) diagnosed by coronary angiography.
Incorporation avoided? All tests	Yes	Disease status (CAD) diagnosed by coronary angiography.
Reference standard results blinded? All tests	No	It is probable that the person who performed the coronary angiogram was aware of the DSE result. However, because later coronary angiograms were performed by an outside institution, this was not necessarily the case (author correspondence).
Index test results blinded? All tests	Yes	All studies were reviewed independently by two experienced echocardiographers who were blinded to the clinical data.
Relevant clinical information? All tests	Yes	Relevant clinical information was provided regarding the performance and analysis of both the index and reference tests.
Uninterpretable results reported? All tests	Yes	No results were reported to be uninterpretable.
Withdrawals explained? All tests	Yes	All patients missing from the final analysis were accounted for.