ASSESSMENT OF THE PROGRESSION OF CARDIAC ALLOGRAFT VASCULOPATHY BY DOBUTAMINE STRESS ECHOCARDIOGRAPHY

Background: After heart transplantation, accelerated coronary vasculop athy is a major factor that limits long-term survival and is usually d etected by serial coronary angiography. The aim of this study was to d etermine whether dobutamine stress echocardiography could accurately i dentify the progression of cardiac allograft vasculopathy. Methods: Tw o sequential controls by dobutamine stress echocardiography were perfo rmed at an 18-month interval in 37 heart transplant recipients at the time of their routine coronary angiography. The first control (control 1) occurred 37 +/- 20 months after transplantation, and the second co ntrol (control 2) occurred after 56 +/- 21 months, Standard echocardio graphic views were acquired at baseline and at incremental dobutamine infusion levels. Regional wall motion score was calculated in a 16-seg ment model, and each segment was graded from 1 (normal) to 4 (dyskines ia). Visual and quantitative coronary angiographic analysis were used to assess the severity of the coronary vasculopathy. Results: The inci dence of coronary vasculopathy increased from 46% (17/37 patients, fou r of whom had stenoses > 50%) at control 1 to 70% (26/37 patients, six of whom had stenoses > 50%) at control 2. Progression of coronary vas culopathy was diagnosed by coronary angiography in 25 patients (new ab normalities in 19 and worsening of previous abnormalities in 6). Dobut amine stress echocardiography correctly identified the progression of vasculopathy in 21 of these 25 patients (84%) with new abnormalities i n 17 and worsening in four. In the four remaining patients with eviden ce of progression of vasculopathy on coronary angiography, the result of dobutamine stress echocardiography was abnormal in three patients a nd normal in only one. Therefore dobutamine stress echocardiography re sults were abnormal in 12 patients at control 1 (sensitivity: 65%, spe cificity: 95%) and in 27 at control 2 (92% sensitivity, 73% specificit y). Conclusion: Dobutamine stress echocardiography is a sensitive, non invasive method to diagnose the progression of allograft vasculopathy, and a negative test result is a strong predictor of absence of allogr aft coronary vasculopathy. Therefore serial routine coronary angiograp hy may be deferred when dobutamine stress echocardiography results are normal.