Dobutamine stress echocardiography for noninvasive diagnosis of cardiac allograft vasculopathy: a comparison with angiography and intravascular ultrasound

This study was performed to assess the value of dobutamine stress echocardiography for noninvasive diagnosis of cardiac allograft vasculopathy (CAV) compared with coronary angiography and intravascular ultrasound (IVUS) in 50 consecutive orthotopic heart transplant recipients. In 46 of 50 patients,...

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Bibliographic Details
Published in:The American journal of cardiology 1996-07, Vol.78 (2), p.168-174
Main Authors: Spes, C H, Mudra, H, Schnaack, S D, Klauss, V, Reichle, F M, Uberfuhr, P, Theisen, K, Angermann, C E
Format: Article
Language:English
Subjects:
Adult
Cardiotonic Agents
Coronary Angiography
Coronary Disease - diagnostic imaging
Dobutamine
Echocardiography
Exercise Test
Feasibility Studies
Graft Occlusion, Vascular - diagnostic imaging
Heart
Heart Transplantation - adverse effects
Humans
Medical research
Middle Aged
Prospective Studies
Sensitivity and Specificity
Transplants & implants
Ultrasonic imaging
Ultrasonography, Interventional
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Summary:This study was performed to assess the value of dobutamine stress echocardiography for noninvasive diagnosis of cardiac allograft vasculopathy (CAV) compared with coronary angiography and intravascular ultrasound (IVUS) in 50 consecutive orthotopic heart transplant recipients. In 46 of 50 patients, a technically adequate echocardiogram could be obtained. Using a 16-segment model, a total of 675 segments were analyzed. At rest, wall motion abnormalities were found in 61 of 675 (9.0%) left ventricular segments in 15 of 46 patients. At maximal dobutamine stress, 103 of 675 segments (15.3%) had wall motion abnormalities (25 of 46 patients). Based on IVUS and angiographic findings, patients were allocated to 2 groups. Group I (n=18) had absent or only mild intimal hyperplasia (mean IVUS grade < or = 3.0 on a 6-grade scale). Group II (n=28) had moderate to severe intimal hyperplasia (mean grade > 3.0 with or without angiographic evidence of CAV. The prevalence of wall motion abnormalities was significantly higher in group II than in group I, both at rest (50 of 415 vs 11 of 270 coronary segments in 13 of 28 vs 2 of 18 patients) and during maximal stress (88 of 415 vs 15 of 270 coronary segments in 22 of 28 vs 3 of 18 patients). Quantitative M-mode echocardiography demonstrated decreased wall thickening in group II versus group I patients at maximal dobutamine dosage in the septum (48 +/- 18% vs 61 +/- 17%; p < 0.01) as well as in the left ventricular posterior wall (77 +/- 21% vs 96 +/- 21%; p
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(96)00252-4