Functional and morphological findings in heart transplant recipients with a normal coronary angiogram: An analysis by dobutamine stress echocardiography, intracoronary Doppler and intravascular ultrasound

Background: Coronary angiography is still the routine screening method for cardiac allograft vasculopathy in most transplant centers. This study was d esigned to analyze functional and morphologic changes in heart transplant r ecipients with normal angiographic findings. Methods: Dobutamine stress echocardiography and intracoronary ultrasound we re obtained in 56 patients with a normal coronary angiogram 41 +/- 31 month s after heart transplantation. Intracoronary Doppler flow velocity measurem ents before and after intracoronary adenosine administration were performed in 34 of 56 patients. Any regional wall motion abnormalities detected by s tress echocardiography were regarded as abnormal. By quantitative intracoro nary ultrasound analysis using a 6-grade scale, a mean grade of all coronar y segments >3.0 was defined as significant intimal hyperplasia. Results: Only 17 patients (30%) showed both a normal dobutamine stress echo cardiogram and absence of significant intimal hyperplasia by intravascular ultrasound. Abnormal findings were observed in 39 patients (70%): both by d obutamine stress echocardiography and intravascular ultrasound in 22 patien ts, by intravascular ultrasound alone in 11 patients, and by dobutamine str ess echocardiography alone in 6 patients. Coronary flow velocity reserve di d not discriminate between patients with normal or abnormal intravascular u ltrasound or dobutamine stress echocardiographic findings. Conclusions: Only a minority of heart transplant patients with a normal cor onary angiogram is free of pathological changes, when assessed by intravasc ular ultrasound and dobutamine stress echocardiography. Coronary flow veloc ity reserve does not seem useful to further characterize these patients. J Heart Lung Transplant 1999; 18:391-398.