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Noninvasive detection of transplant coronary artery disease by dobutamine stress echocardiography
K O Akosah1, P K Mohanty, J T Funai
1Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Va.
Insights
Dobutamine stress echocardiography effectively rules out significant allograft coronary artery disease in heart transplant patients. A normal test predicts a low risk of cardiac events, aiding in noninvasive surveillance.
Area of Science:
- Cardiology
- Transplant Medicine
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a major cause of death in heart transplant recipients.
- Allograft CAD incidence reaches 40-50% by 5 years post-transplant.
- Noninvasive detection of allograft CAD remains challenging.
Purpose of the Study:
- Evaluate dobutamine stress echocardiography (DSE) for noninvasive screening of significant allograft CAD.
- Assess the prognostic value of DSE in heart transplant recipients.
Main Methods:
- Standard DSE protocol with escalating dobutamine doses (5-40 µg/kg/min).
- Continuous ECG and blood pressure monitoring.
- Analysis of left ventricular wall motion at rest and peak stress.
Main Results:
- DSE demonstrated 95% sensitivity and 92% negative predictive accuracy for significant allograft CAD.
- Specificity was 55%, with a positive predictive accuracy of 69%.
- Patients with abnormal DSE had 15 major cardiac events in 12 months; none occurred in those with normal DSE.
Conclusions:
- DSE is a valuable noninvasive tool for ruling out significant allograft CAD in heart transplant patients.
- Normal DSE findings correlate with a low risk of future cardiac events.
- DSE aids in the surveillance and risk stratification of heart transplant recipients.
Abstract:
Coronary artery disease has emerged as the leading cause of late morbidity and mortality in heart transplant recipients. The incidence of allograft coronary artery disease has been reported to be as high as 40% to 50% by 5 years. Coronary angiography remains the standard approach for surveillance of coronary artery disease in this patient population. However, the detection and surveillance of allograft coronary disease by noninvasive methods remains a challenge. The purpose of this study was to determine the value of dobutamine stress echocardiography as a noninvasive screening test to rule out the presence of anatomically significant allograft coronary artery disease and to assess its prognostic power. Dobutamine stress echocardiography was carried out according to a standard protocol in which dobutamine was infused at 5, 10, 20, 30, and 40 micrograms/kg/min intravenously at 5-minute stages with 12-lead electrocardiogram and blood pressure monitoring. Left ventricular wall motion was analyzed at baseline and at peak dobutamine dose. Mean age (+/- standard error of the mean) of the study population was 50.5 +/- 1.5 years, and mean duration (+/- standard error of the mean) since transplantation was 57 +/- 5 months. The sensitivity, specificity, and positive and negative predictive accuracy of dobutamine stress echocardiography were 95%, 55%, 69%, and 92%, respectively. In the 12-month follow-up study 12 patients with abnormal dobutamine stress echocardiographic findings had 15 major cardiac events whereas no event occurred in patients with normal dobutamine stress echocardiograms.(ABSTRACT TRUNCATED AT 250 WORDS)