The online version of this article (doi:10.1186/1476-7120-10-44) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
GM: concept and design, analysis and interpretetion, critical revisions and data collection; GZ: concept and design, analysis and interpretetion, drafting manuscript and data collection; AP: analysis and interpretetion and data collection; GP: concept and design, analysis and interpretetion and critical revisions; MS: literature search and data collection; FMO: literature search and data collection; GP: literature search and data collection PLDM: literature search and data collection. GC: analysis and interpretetion, drafting manuscript and data collection; FM: analysis and interpretation and critical revisions. All authors read and approved the final manuscript.
Cardiac allograft vasculopathy (CAV) is a major late complication in cardiac transplant recipients and has a relevant impact on outcome of these patients. Aims of this study: to compare, in cardiac transplant recipients patients, the diagnostic value of pressure/volume relationship (ESPVR) during dobutamine stress echocardiography (DSE) for coronary artery disease, assessed by Multislice Computed Tomography (MSCT), and by coronary angiography (CA). We also analyzed any possible relationship between ESPVR and the Health Related Quality of Life of the patients (HRQoL), evaluated by SF–36 questionnaire.
25 consecutive patients underwent DSE within 24 hours after MSCT coronary angiogram and then they underwent CA. The HRQoL questionnaire was administered to the patients in the settings of DSE. They were followed-up for 6 months.
DSE has a sensitivity in detecting CAV of 67%, specificity of 95%, positive predictive value of 67% and negative predictive value of 95%; DSE with ESPVR has a sensitivity of 100%, specificity of 95%, positive predictive value of 75%, negative predictive value of 100%; MSCT has a sensitivity of 100%; specificity of 82%; positive predictive value of 43%; negative predictive value of 100%. Htx recipients with a flat-biphasic ESPVR, although asymptomatic, perceived a worst HRQoL compared with the up-sloping ESPVR population, and this is statistically significant for the general health (p 0.0004), the vitality (p 0.0013) and the mental health (p 0.021) SF-36 subscale.
Evaluation with DSE and ESPVR is accurate in the clinical control of heart transplant recipients reserving invasive evaluation only for patients with abnormal contractility indexes.
Wilson RF, Mc Ginn AL, Johnson TH, et al: Sympathetic reinnervation after heart transplantation in human beings. J Heart Lung Transplant. 1992, 11: S88-S89. PubMed
Akosah KO, Mohanty PK, Funai JT, et al: Noninvasive detection of transplant coronary artery disease by dobutamine stress echocardiography. J Heart Lung Transplant. 1994, 13: 1024-1038. PubMed
Akosah KO, Olsovsky M, Kirchberg D, et al: Dobutamine stress echocardiography predicts cardiac events in heart transplant patients. Circulation. 1996, 94: SII283-SII288.
Bombardini T, Agrusta M, Natsvlishvili N, et al: Noninvasive assessment of left ventricular contractility by pacemaker stress echocardiography. Eur J Heart Fail. 2005, 2: 173-181. CrossRef
Francis GS, Greenberg BH, Hsu DT, Jaski BE, Jessup M, LeWinter MM, Pagani FD, Piña IL, Semigran MJ, Walsh MN, Wiener DH, Yancy CW: ACCF/AHA/ACP/HFSA/ISHLT 2010 clinical competence statement on management of patients with advanced heart failure and cardiac transplant: a report of the ACCF/AHA/ACP Task Force on Clinical Competence and Training. J Am Coll Cardiol. 2010, 56: 424-53. 10.1016/j.jacc.2010.04.014. CrossRefPubMed
Ware JE, Kosinkski M, Gandek B: SF–36. Health survey: manual and interpretation guide. 2000, Lincoln, RI: Quality Metric, Inc
Apolone G, Mosconi P: The Italian SF-36 health survey: translation, validation and norming. J Clin Epidemiol. 1998, 11: 1025-1036. CrossRef
von Ziegler F, Leber AW, Becker A, et al: Detection of significant coronary artery stenosis with 64-slice computed tomography in heart transplant recipients: a comparative study with conventional coronary angiography. Int J Cardiovasc Imaging. 2009, 25: 91-100. 10.1007/s10554-008-9343-z. CrossRefPubMed
The international society of heart and lung transplantation guidelines for the care of heart transplant recipients: TASK FORCE 3: long-term care of heart transplant recipients. J Heart Lung Transpl. 2010, 29 (8): 914-956. 10.1016/j.healun.2010.05.034. CrossRef
- The pressure/volume relationship during dobutamine stress echocardiography in transplanted heart: comparison with quality of life and coronary anatomy
Francesca Moschella Orsini
Paola Lilla Della Monica
- BioMed Central
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