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Noninvasive assessment of transplant-associated arteriosclerosis
1Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115, USA.
Insights
Noninvasive methods for assessing cardiac transplant arteriosclerosis show variable accuracy. Dobutamine echocardiography and radionuclide scintigraphy offer valuable adjunctive information to angiography for guiding patient care.
Area of Science:
- Cardiology
- Transplantation Medicine
- Vascular Biology
Background:
- Transplant-associated arteriosclerosis significantly limits long-term survival in cardiac transplant recipients.
- Annual surveillance angiography is standard but is invasive, costly, and insensitive.
- Development of reliable noninvasive assessment methods is crucial.
Purpose of the Study:
- To review and evaluate noninvasive testing methods for assessing cardiac allograft arteriosclerosis.
- To determine the reliability and limitations of various noninvasive techniques.
Main Methods:
- Comprehensive literature search of MEDLINE and reference reviews.
- Identification of publications on noninvasive assessment of cardiac allografts.
- Focus on studies related to transplant-associated arteriosclerosis.
Main Results:
- Resting/stress ECG, radionuclide scintigraphy, echocardiography, and PET have yielded variable results.
- Pharmacologic stress imaging (e.g., dobutamine echocardiography) may improve sensitivity.
- Some methods like radionuclide scintigraphy show good specificity; absolute coronary blood flow measurement is promising but costly.
Conclusions:
- Noninvasive techniques for transplant-associated coronary arteriosclerosis have limitations in sensitivity and specificity.
- Dobutamine echocardiography and radionuclide scintigraphy provide important adjunctive data to angiography.
- These methods can aid in managing cardiac transplant recipients with allograft coronary arteriosclerosis.
Background:
Transplant-associated arteriosclerosis is the major limitation to long-term survival in the cardiac transplant recipient, and annual surveillance angiography is used in many centers to monitor its progression. Noninvasive methods would be preferable because angiography is invasive, costly, and insensitive; however, the reliability of such methods has been questioned.
Methods:
All publications relating to the assessment of the cardiac allograft by noninvasive testing were identified through MEDLINE and a review of references from the published literature on transplant-associated arteriosclerosis.
Results:
Resting and stress ECG, radionuclide scintigraphy, echocardiography, and positron emission tomography have all been used in cardiac transplant recipients with variable results. Most techniques are insensitive, but this limitation may be improved with pharmacologic stress imaging like dobutamine echocardiography. Although insensitive, some methods have good specificity (i.e., radionuclide scintigraphy). The noninvasive measurement of absolute coronary blood flow is promising as a specific and sensitive technique but is limited by availability and cost.
Conclusions:
In general, noninvasive techniques to assess transplant-associated coronary arteriosclerosis are limited by variable sensitivity and specificity. However, certain methods, such as dobutamine echocardiography and radionuclide scintigraphy, can provide important adjunctive physiologic information to angiography. Such techniques can therefore help to guide the care and treatment of the cardiac transplant recipient with allograft coronary arteriosclerosis.
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