Clinical heart transplantationDobutamine stress echocardiography predicts cardiac events or death in asymptomatic patients long-term after heart transplantation: 4-Year prospective evaluation
Section snippets
Study population
We studied 39 of 58 patients who had survived >4 years after orthotopic heart transplantation at the time of initial enrollment. Average age was 48 ± 13 years, and mean follow-up after heart transplantation was 86 ± 31 months. We enrolled patients with normal ventricular systolic function as shown with resting echocardiography, with no symptoms of angina or heart failure, with no episodes of acute rejection, and who adhered to the study protocol. Patients signed a special informed consent in
Results
Of the 39 patients studied, 15 (38.4%) had allograft vasculopathy shown by coronary angiography and characterized by an obstructive coronary lesion of ≥50% in at least 1 vessel at the initial evaluation.
Table 1 shows the association between clinical and laboratory data, and the presence of CAV. The group with CAV had a tendency toward greater weight but with no statistical significance (68.8 ± 13.5 kg vs 78.5 ± 19.1 kg; p = 0.072). Patients with coronary vasculopathy showed greater BMI than
Discussion
Difficulty in detecting and treating CAV remains the major limiting factor for survival after heart transplantation, especially after the 1st year of clinical follow-up. Clinically, the disease is silent because of cardiac denervation, and when symptoms develop, we observe manifestations of advanced disease, such as heart failure, myocardial infarction, and sudden death. Some immune and non-immune risk factors seem to contribute to the development of the disease, but the results in many series
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Post-transplant surveillance for acute rejection and allograft vasculopathy by echocardiography: Usefulness of myocardial velocity and deformation imaging
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2015, Journal of Heart and Lung TransplantationCitation Excerpt :Based on that rationale, non-invasive testing to detect CAV has become an attractive option in transplant recipients, and multiple imaging modalities have been investigated as alternative screening tests to extend the interval between ICAs performed after OHT. Multiple studies have evaluated the ability of DSE compared with ICA and showed sensitivity, specificity, PPV and NPV for the diagnosis of CAV to range from 63% to 95%, 55% to 95%, 40% to 92% and 62% to 92%, respectively, depending on the angiographic definitions of CAV used (varying from any angiographic abnormalities to stenosis of ≥50%).9,11–13,20,23,24 The sensitivity and NPV of DSE to detect any stage of CAV found in our study were very low (7% and 41%, respectively).
Follow-up of heart transplant recipients with serial echocardiographic coronary flow reserve and dobutamine stress echocardiography to detect cardiac allograft vasculopathy
2014, Journal of the American Society of Echocardiography