Diagnostic and prognostic value of serial dobutamine stress echocardiography for noninvasive assessment of cardiac allograft vasculopathy - A comparison with coronary angiography and intravascular ultrasound

Background-Routine methods for surveillance of cardiac allograft vasculopat hy (CAV) are coronary angiography and intravascular ultrasound (IVUS). This study analyzed the diagnostic and prognostic value of dobutamine stress ec hocardiography (DSE) for noninvasive assessment of CAV. Methods and Results-In 109 heart transplant recipients, 333 DSEs were compa red with 285 coronary angiograms and 199 IVUS analyses. Studies were repeat ed after 1, 2, 3, 4, and greater than or equal to 5 years in 88, 74, 37, 18 , and 7 patients, respectively. Resting 2D echocardiography detected CAV de fined by IVUS and angiography with a sensitivity of 57% (specificity 88%). DSE increased the sensitivity to 72% (P=0.002). M-mode analysis increased t he sensitivity of 2D rest and stress analysis (P=0.001, 0.004). Cardiac eve nts occurred after 1.9% of normal stress tests by 2D analysis (combined 2D and M-mode: 0%), compared with 6.3% (3.8%) of normal resting studies. Worse ning of serial DSE indicated an increased risk of events compared with no d eterioration (relative risk 7.26, P=0.0014). Serial deterioration detected by stress only was associated with a higher risk of events than changes evi dent from resting studies (relative risk 3.06, P=0.0374). Conclusions-DSE identifies patients at risk for events and facilitates moni toring of CAV. A normal DSE predicts an uneventful clinical course and just ifies postponement of invasive studies. The prognostic value of DSE is comp arable to that of IVUS and angiography.