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901-27 Regional Wall Motion Analysis by Dobutamine Stress Echocardiography in Heart Transplant Recipients with Normal Coronary Angiographic Findings: Comparison with Intravascular Ultrasound
Coronary angiography (ANGlO) is still the reference method for diagnosis of coronary allograft vasculopathy (CAV). To investigate, if normal ANGlO excludes CAV, 42 patients (P, 51±7 yrs, 49±22 months after heart transplantation) were studied prospectively by ANGlO, intravascular ultrasound (IVUS, qu...
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Published in: | Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.11A-11A |
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Main Authors: | , , , , , , , , , , |
Format: | Article |
Language: | English |
Online Access: | Get full text |
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Summary: | Coronary angiography (ANGlO) is still the reference method for diagnosis of coronary allograft vasculopathy (CAV). To investigate, if normal ANGlO excludes CAV, 42 patients (P, 51±7 yrs, 49±22 months after heart transplantation) were studied prospectively by ANGlO, intravascular ultrasound (IVUS, quantitative analysis of degree and extension of intimal hyperplasia; modified Stanford grading, grades 1–6) and dobutamine stress echocardiography (DSE, 5–40 mcg/kg/min, 5 min stages). Regional wall motion abnormalities (WMA) were assessed qualitatively (2-D-echo, 16 segment model) and quantitatively (M-Mode, systolic wall thickening of septum (IVS) and LV posterior wall (LPW). P with allograft rejection (>grade lA ISHLT) were excluded from analysis. ANGlO was completely normal in 33 P; these P were allocated according to mean IVUS grading (mean, 4.1 coronary segments per P): groupl, mild-to-moderate intimal hyperplasia (mean grade<3.5), n=20; group2, marked-to-severe intimal hyperplasia (mean IVUS grade ≥ 3.5), n=13. No groupl P had WMA at rest, 2/20 P developed WMA during DSE (6/320 segments). In group2, WMA at rest were found in 6/13P (26/208 segmentsl. During DSE, WMA increased in these 6P and newly developed in 6 P (total. WMA in 12/13 group2 P in 72/208 segments during DSE). Mean systolic thickening of IVS (group2 vs. 1: rest, 23 vs. 33%, p<0.01; max. DSE, 32 vs. 62%, P<0.01) and LPW (rest, 38 vs. 58%, P<0.01, max. DSE, 65 vs. 96%, p<0.01) were signif. smaller in group2 than groupl. In total, in 15/33 P with normal ANGlO, evidence of CAY was found (IVUS≥3.5 and WMA at DSE, n=12; IVUS ≥ 3.5 only, n=1; WMA at DSE alone, n=2).
A normal ANGlO does not rule out CAV WMA during DSE are associated with marked to severe intimal changes as assessed by IVUS. These changes appear to preceede ANGlO changes. Analysis of WMA by DSE is a feasible noninvasive method for early detection of CAV Costly and invasive ANGlO, in particular when performed without IVUS, may be not necessary at regular annual intervals in heart transplant recipients with normal DSE findings. |
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ISSN: | 0735-1097 1558-3597 |
DOI: | 10.1016/0735-1097(95)91504-Q |