E. Gunther et al., DOBUTAMINE STRESS ECHOCARDIOGRAPHY IN PATIENTS AFTER HEART-TRANSPLANTATION - INITIAL EXPERIENCE, Zeitschrift fur Kardiologie, 84(5), 1995, pp. 411-418
Cardiac allograft vasculopathy (CAV) has become one of the primary obs
tacles to long-term survival of patients after heart transplantation.
The low sensitivity of currently available noninvasive tests still rem
ains a problem in the early diagnosis of the disease. To assess the fe
asibility, safety, and usefulness of dobutamine stress echocardiograph
y as a noninvasive predictor of cardiac allograft vasculopathy, we exa
mined 20 patients (3 female) 3-35 months after orthotopic heart transp
lantation. All patients underwent coronary angiography within 2 weeks
of dobutamine stress echocardiography. Results: 89 % of the segments e
xamined could be evaluated for wall motion abnormalities. Under increa
sing doses of dobutamine (5 to max. 30 mu g/kg/min), heart rate increa
sed from 88 +/- 13 bpm to 141 +/- 16 bpm, and systolic blood pressure
from 139 +/- 14 mmHg to 154 +/- 28 mm Hg. Two of 4 patients with angio
graphically detected CAV developed new wall motion abnormalities under
dobutamine; their wall motion score increased from 1.23 +/- 0.22 to 1
.31 +/- 0.24. In the other patients without CAV, the wall motion score
remained almost unchanged (1.01 +/- 0.3 to 1.02 +/- 0.4). Dobutamine
was well tolerated, and there were no serious complications. Thus, dob
utamine stress echocardiography seems to be feasible and safe in patie
nts after heart transplantation. Our results suggest that it might be
useful for the detection of cardiac allograft vasculopathy. The final
determination of its clinical usefulness in the diagnosis of cardiac a
llograft vasculopathy needs further extensive investigations.