THE SPECIFICITY OF NORMAL QUALITATIVE ANGIOGRAPHY IN EXCLUDING CARDIAC ALLOGRAFT VASCULOPATHY

It has been frequently stated that qualitative coronary angiography is insensitive in the diagnosis of cardiac allograft vasculopathy becaus e the disease can be diffuse without observable luminal irregularities . However, the specificity of otherwise normal qualitative coronary an giography for excluding cardiac allograft vasculopathy has not been pr ospectively studied. Accordingly, 28 patients who underwent transplant ation from June 23, 1989 to July 9, 1990 underwent coronary angiograph y within 3 weeks (predischarge) after transplantation and at 1 year. T wenty-one of these patients who had both normal 1-year qualitative cor onary angiography and predischarge angiograms adequate for analysis se rved as the study cohort. Cross-section luminal diameters (average, 14 .3 per angiogram) were measured at the same branch points on each pair of angiograms in the right anterior oblique view. Seventeen of the 21 patients had no change in average luminal diameters, while the remain ing four patients had consistent narrowing in all vessels and in all s egments. In these four patients, the mean fall in luminal diameter was 20% +/- 2%. The specificity of normal qualitative angiography in pred icting absence of cardiac allograft vasculopathy is 81%. In conclusion , qualitative angiography usually predicts the absence of cardiac allo graft vasculopathy. However, 15% to 20% of patients will have diffuse disease not detected by a normal study.