Related Experiment Videos
Dobutamine stress echocardiography after heart transplantation
M C Herregods1, I Anastassiou, J Van Cleemput
1Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
Dobutamine stress echocardiography is not suitable for detecting early transplant vasculopathy in heart transplant recipients. The test did not reveal significant wall motion abnormalities, even in patients with known coronary artery disease.
Area of Science:
- Cardiology
- Transplant Medicine
- Diagnostic Imaging
Background:
- Transplant vasculopathy is a major cause of late graft loss after heart transplantation.
- Early detection of transplant vasculopathy is crucial for patient management.
- Dobutamine stress echocardiography is a common tool for assessing coronary artery disease in the general population.
Purpose of the Study:
- To evaluate the utility of dobutamine stress echocardiography (DSE) for detecting and staging transplant vasculopathy in heart transplant recipients.
- To compare DSE findings in heart transplant recipients with and without angiographic evidence of coronary artery disease.
Main Methods:
- Dobutamine stress echocardiography was performed in 28 heart transplant recipients.
- Patients were divided into two groups: 14 with angiographic coronary artery disease and 14 with normal coronary arteries.
- The dobutamine infusion protocol involved incremental doses until maximal heart rate was achieved.
Main Results:
- No patient demonstrated deterioration of global or regional wall motion during dobutamine stress.
- In patients with existing coronary artery disease, wall motion abnormalities at rest normalized in 5 out of 7 under dobutamine stress.
- In patients with normal coronary arteries, resting wall motion abnormalities normalized in all cases under dobutamine stress.
Conclusions:
- The standard dobutamine stress echocardiography protocol is unsuitable for the early detection of transplant vasculopathy in heart transplant recipients.
- Functional sequelae of transplant vasculopathy may not be prominent, potentially due to underestimation of disease extent by angiography.
Abstract:
Dobutamine stress echocardiography was performed in 28 heart transplant recipients to study its value in the detection and staging of transplant vasculopathy. Fourteen patients had angiographic evidence of coronary artery disease (group 1), and 14 had angiographically normal coronary arteries (group 2). The dobutamine stress protocol called for a dose increase of dobutamine every 3 minutes until the age-predicted maximal heart rate was achieved. In groups 1 and 2, the mean maximal dose of dobutamine was, respectively, 24 +/- 9 micrograms/kg min and 29 +/- 8 micrograms/kg min, and the mean rate-pressure product was, respectively, 12386 +/- 1777 mm Hg/min and 10753 +/- 1085 mm Hg/min at rest, increasing to 20987 +/- 4020 mm Hg/min and 19795 +/- 2728 mm Hg/min at maximal dose. No patient in group 1 or 2 had deterioration of global or regional wall motion under dobutamine stress. In group 1, seven patients had wall motion abnormalities at rest, normalizing in five of them under dobutamine stress. In group 2, four patients had wall motion abnormalities at rest, normalizing in all patients under dobutamine stress. Consequently, this protocol of dobutamine stress echocardiography is unsuitable for the early detection of transplant vasculopathy despite its proven value in the general population. Conversely, these data suggest that the functional sequelae of transplant vasculopathy are not necessarily prominent, despite the known angiographic underestimation of the extent of the disease.