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[Initial experiences with dobutamine stress echocardiography in heart transplant patients]
F Günther1, E Schwammenthal, A Rahmel
1Medizinische Klinik und Poliklinik, Innere Medizin C, Münster.
Insights
Dobutamine stress echocardiography shows promise for detecting cardiac allograft vasculopathy (CAV) after heart transplantation. This noninvasive test appears feasible and safe, aiding early diagnosis of CAV.
Area of Science:
- Cardiology
- Transplant Medicine
- Diagnostic Imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a major challenge for long-term heart transplant survival.
- Current noninvasive tests lack sensitivity for early CAV detection.
Purpose of the Study:
- To evaluate dobutamine stress echocardiography (DSE) as a noninvasive predictor of CAV.
- To assess the feasibility and safety of DSE in heart transplant recipients.
Main Methods:
- 20 heart transplant patients underwent DSE and coronary angiography.
- Wall motion abnormalities were assessed during dobutamine infusion.
Main Results:
- DSE was feasible and safe in heart transplant patients.
- Dobutamine induced wall motion abnormalities in patients with CAV.
- Wall motion scores increased in patients with CAV but remained stable in those without.
Conclusions:
- Dobutamine stress echocardiography may be a useful noninvasive tool for detecting cardiac allograft vasculopathy.
- Further extensive research is needed to confirm its clinical utility in diagnosing CAV.
Unlabelled:
Cardiac allograft vasculopathy (CAV) has become one of the primary obstacles to long-term survival of patients after heart transplantation. The low sensitivity of currently available noninvasive tests still remains a problem in the early diagnosis of the disease. To assess the feasibility, safety, and usefulness of dobutamine stress echocardiography as a noninvasive predictor of cardiac allograft vasculopathy, we examined 20 patients (3 female) 3-35 months after orthotopic heart transplantation. All patients underwent coronary angiography within 2 weeks of dobutamine stress echocardiography.
Results:
89% of the segments examined could be evaluated for wall motion abnormalities. Under increasing doses of dobutamine (5 to max. 30 micrograms/kg/min), heart rate increased from 88 +/- 13 bpm to 141 +/- 16 bpm. and systolic blood pressure from 139 +2- 14 mm Hg to 154 +/- 28 mm Hg. Two of 4 patients with angiographically detected CAV developed new wall motion abnormalities under dobutamine; their wall motion score increased from 1.23 +/- 0.22 to 1.31 +/- 0.24. In the other patients without CAV, the wall motion score remained almost unchanged (1.01 +/- 0.3 to 1.02 +/- 0.4). Dobutamine was well tolerated, and there were no serious complications. Thus, dobutamine stress echocardiography seems to be feasible and safe in patients after heart transplantation. Our results suggest that it might be useful for the detection of cardiac allograft vasculopathy. The final determination of its clinical usefulness in the diagnosis of cardiac allograft vasculopathy needs further extensive investigations.