Dobutamine echocardiography in children after cardiac transplantation.

Coronary disease of the transplanted heart is the principal cause limiting long-term survival of patients and grafts. In view of the invasive nature o f coronary angiography, dobutamine echocardiography has been proposed as a non-invasive diagnostic method for this disease. The aim of this study was to determine the feasibility and reliability of this investigation in trans planted children. Twenty-one echos were performed with dobutamine infusions in 17 patients tr ansplanted at 10 months to 16.9 years of age (average 8.4 years), and follo wed up 1.1 to 10.1 years (average 4.4 years) : 4 were on antihypertensive d rugs but none were treated by betablockers. Dobutamine echocardiography was performed according to the standard protoco l used in adults. The maximal level was attained in all cases. No major sid e effects were observed. The maximal heart rate attained 57 to 89% of the t heoretical maximal rate, an increase of 44 to 184% compared with the basal heart rate. The maximal systolic blood pressure rose to 120 to 194 mmHg, an increase of 8 to 109% compared with resting values. The contractility scor es and segmental contractile index were normal in 18 cases, abnormal at the maximal level in 2 cases (hypokinesia of segments 8 and 9 and akinesia of segments 10 and 16 with an index of 1.2), abnormal at the lowest levels (hy pokinesia of segment 7 with an index of 1.1) and maximal level (hypokinesia of segments 1 and 7 with an index of 1.2) in one case. These results were concordant with coronary angiography performed within 2 to 8 days of echoca rdiography, and considered as the diagnostic investigation of reference (se nsitivity 75%, specificity 100%, positive predictive value 100% and negativ e predictive value 93%). The authors conclude that dobutamine echocardiography is a non-invasive met hod easily performed with low risk in transplanted children but its diagnos tic performance in coronary disease of the transplanted heart should be con firmed in larger studies.