NONINVASIVE ASSESSMENT OF TRANSPLANT-ASSOCIATED ARTERIOSCLEROSIS

Background Transplant-associated arteriosclerosis is the major limitat ion to long-term survival in the cardiac transplant recipient, and ann ual surveillance angiography is used in many centers to monitor its pr ogression. Noninvasive methods would be preferable because angiography is invasive, costly, and insensitive; however, the reliability of suc h methods has been questioned. Methods All publications relating to th e assessment of the cardiac allograft by noninvasive testing were iden tified through MEDLINE and a review of references from the published l iterature on transplant-associated arteriosclerosis. Results Resting a nd stress EGG, radionuclide scintigraphy, echocardiography, and positr on emission tomography have all been used in cardiac transplant recipi ents with variable results. Most techniques are insensitive, but this limitation may be improved with pharmacologic stress imaging like dobu tamine echocardiography. Although insensitive, some methods have good specificity (i.e., radionuclide scintigraphy). The noninvasive measure ment of absolute coronary blood Row is promising as a specific and sen sitive technique but is limited by availability and cost. Conclusions In general, noninvasive techniques to assess transplant-associated cor onary arteriosclerosis are limited by variable sensitivity and specifi city. However, certain methods, such as dobutamine echocardiography an d radionuclide scintigraphy, can provide important adjunctive physiolo gic information to angiography. Such techniques can therefore help to guide the care and treatment of the cardiac transplant recipient with allograft coronary arteriosclerosis.