DOBUTAMINE STRESS ECHOCARDIOGRAPHY FOR ASSESSING CORONARY-ARTERY DISEASE AFTER TRANSPLANTATION IN CHILDREN

Objectives. The purpose of this study was to determine the feasibility , safety and diagnostic accuracy of dobutamine stress echocardiography (DSE) for evaluating posttransplant coronary artery disease (TxCAD) i n children, and to determine the frequency of selected cardiac events after normal or abnormal DSE. Background. Posttransplant coronary arte ry disease is the most common cause of graft loss (late death or retra nsplantation) after cardiac transplantation (CTx) in children. Coronar y angiography, routinely performed to screen for TxCAD, is an invasive procedure with limited sensitivity. The efficacy of DSE for detecting atherosclerotic coronary artery disease is established, but is unknow n in children after CTx. Methods. Of the 78 children (median age 5.7 y ears, range 3 to 18) entered into the study, 72 (92%) underwent diagno stic DSE by means of a standard protocol, 4.6 +/- 1.9 years after CTx. The results of coronary angiography performed in 70 patients were com pared with DSE findings. After DSE, subjects were monitored for TxCAD- related cardiac events, including death, retransplantation and new ang iographic diagnosis of TxCAD. Results. No major complications occurred . Minor complications, most often hypertension, occurred in 11% of the 72 subjects. The sensitivity and specificity of DSE were 72% and 80%, respectively, when compared with coronary angiography. At follow-up ( 21 +/- 8 months), TxCAD related cardiac events occurred in 2 of 50 chi ldren (4%) with negative DSE, versus 6 of 22 children (27%) with posit ive DSE (p < 0.01). Conclusions. DSE is a feasible, safe and accurate screening method for TxCAD in children. Positive DSE identifies patien ts at increased risk of TxCAD-related cardiac events. Negative DSE pre dicts short-term freedom from such events.