PERCUTANEOUS CORONARY ANGIOSCOPY IN THE D IAGNOSIS OF CARDIAC GRAFT CORONARY-DISEASE - COMPARISON WITH THE RESULTS OF ANGIOGRAPHY

Coronary disease in cardiac transplant patients is a major factor in t he limitation of long term survival. The aim of this study was to comp are the results of angioscopy with those of coronary angiography perfo rmed systematically every 18 months in our center. Twenty-nine patient s (31 angioscopies) were assessed 38 +/- 21 months after transplantati on. The appearance observed by angioscopy were : 1) normal, 2) yellow pigmentation of the arterial surface, 3) elevated plaque < 50 %, 4) el evated plaque greater than or equal to 50 % stenosis. Angiography was : 1) normal, 2) iregularities of the lumen or < 50 % stenosis, 3) grea ter than or equal to 50 % stenosis. The films were viewed by two indep endent investigators. Angioscopy was performed on the left anterior de scending artery (N = 35), the left circumflex (N = 24) and the right c oronary artery (N = 9). One to three arterial segments were examined p er vessel (total of 117 segments : average 3.8 segments per patient). Angioscopy was uninterpretable in 13/117 (11 %) of cases. Of the 81 (7 8 %) segments considered normal at coronary angiography, only SS seeme d normal at angioscopy (68 %). Of the 23 segments considered to be abn ormal at coronary angiography, all were also considered to be abnormal at angioscopy.The authors conclude that coronary angioscopy seems to be more sensitive than coronary angiography for the detection of coron ary disease due to chronic rejection. Prospective studies are required to determine whether the infra-angiographic angioscopic lesions corre spond to earlier stages of coronary disease of the cardiac graft.