PROGNOSTIC VALUE OF NONINVASIVE TESTING ONE-YEAR AFTER ORTHOTOPIC CARDIAC TRANSPLANTATION

Objectives. We sought to evaluate the prognostic value of routine noni nvasive testing-stress thallium-201 imaging, rest two-dimensional echo cardiography and rest equilibrium radionuclide angiography-1 year afte r cardiac transplantation. Background. Coronary artery vasculopathy is the most important cause of late death after orthotopic cardiac trans plantation. Several clinical variables have been identified as risk fa ctors for development of coronary vasculopathy. Traditional noninvasiv e diagnostic testing has been shown to be relatively insensitive for i dentifying patients with angiographic vasculopathy. Methods. Results o f prospectively acquired noninvasive testing in 47 consecutive transpl ant recipients alive 1 year after transplantation were related to subs equent survival. Other clinical variables previously shown to be assoc iated with the development of coronary artery vasculopathy were also i ncluded in the analysis. Results. The 5-year survival rate after cardi ac transplantation was 81%. By univariate analysis, echocardiography ( chi-square 9.21) and stress thallium-201 myocardial perfusion imaging (chi-square 16.76) were predictive for survival, whereas rest equilibr ium radionuclide angiography was not. Clinical contributors to surviva l were donor age (chi-square 4.56), number of human leukocyte antigen mismatches (chi-square 3.06) and cold ischemic time (chi-square 3.23). By multivariate analysis, stress myocardial imaging remained the only significant predictor of survival (risk ratio 0.27; 95% confidence in terval 0.06 to 0.89). Conclusions. Normal thallium-201 stress myocardi al perfusion imaging 1 year after cardiac transplantation is an import ant predictor of 5-year survival.