THE PROGNOSTIC-SIGNIFICANCE OF NONINVASIVE CARDIAC TESTS IN HEART-TRANSPLANT RECIPIENTS

The long-term mortality and morbidity of cardiac transplant recipients is related to their subsequent development of accelerated coronary at heroma and its complications. Coronary angiography was compared with n on-invasive clinical assessment to see which was better in predicting clinical outcome. Ninety-one consecutive transplant recipients (mean a ge 53 years), in whom investigations had been performed (exercise elec trocardiography, rest and exercise radionuclide ventriculography, 2-D echocardiography and coronary angiography), were followed up for a mea n period of 2.1 years, Eighteen patients had 31 cardiac events. There were five cardiac-related deaths, 17 myocardial infarctions and/or ons ets of heart failure, light percutaneous transluminal coronary angiopl asties and one coronary artery bypass graft. With cardiac event-free s urvival as the dependent variable and the results of the above investi gations as independent variables, a series of univariate, bivariate an d regression analyses were performed. On bivariate analysis, an echoca rdiographic ejection fraction of >60% significantly predicted both sur vival free of myocardial infarction and/or heart failure and/or cardia c death and survival free of any cardiac event (P=0.001 for both). Abs ence of coronary angiographic disease (both of <25% and of <50% lumina l narrowing in any vessel) significantly predicted survival free of an y cardiac event (P=0.00004 and 0.015, respectively). Neither radionucl ide ventriculography nor exercise electrocardiography were significant predictors of event free survival. In conclusion, echocardiography is at least as important as coronary angiography in the follow-up and pr ognostic assessment of cardiac transplant recipients.