Myocardial scintigraphy correlates poorly with coronary angiography in thescreening of transplant arteriosclerosis

Citation
Jf. Legare et al., Myocardial scintigraphy correlates poorly with coronary angiography in thescreening of transplant arteriosclerosis, CAN J CARD, 17(8), 2001, pp. 866-872
Citations number
31
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
CANADIAN JOURNAL OF CARDIOLOGY
ISSN journal
0828282X → ACNP
Volume
17
Issue
8
Year of publication
2001
Pages
866 - 872
Database
ISI
SICI code
0828-282X(200108)17:8<866:MSCPWC>2.0.ZU;2-T
Abstract
BACKGROUND: Coronary angiography remains an important screening tool for tr ansplant coronary arteriosclerosis (TxCAD) after heart transplantation desp ite criticism that it underestimates mates the incidence of TxCAD. In an ef fort to improve TxCAD incidence estimation, several methods of screening ha ve been proposed. In the present study, the incidence of TxCAD assessed by both yearly coronary angiography and stress myocardial scintigraphy imaging was reviewed. PATIENTS AND METHODS: Ninety-nine consecutive primary heart transplantation s were performed from 1988 to 1999. The standard immunosuppression protocol consisted of the introduction of antilymphocyte globulin and steroids, whi le maintenance therapy was with cyclosporine, imuran and steroids. Coronary angiography and a stress 2-methoxyisobutyl-isonitrile perfusion scan were performed yearly. TxCAD was defined by angiographic evidence of luminal abn ormality by catheterization, or a perfusion abnormality at rest or after st ress on myocardial scintigraphy. RESULTS: The mean recipient age was 49 +/- 12 years and the mean donor age was 33 +/- 13 years. The etiology of heart failure was ischemic cardiomyopa thy (50%), dilated cardiomyopathy (41%) and congenital heart disease (9%). The freedom from angiographic TxCAD was 92% at one year, 64% at five years and 35% at eight years. The freedom from nuclear imaging TxCAD was 92% at o ne year, 69% at five years and 44% at eight years. However, a diagnosis of TxCAD by angiography only correlated with a diagnosis of TxCAD by nuclear i maging 52.8% of the time in the same patient, with a median time between st udies of one month. CONCLUSION: The overall incidence of TxCAD diagnosed by angiography and nuc lear imaging appears similar but correlates poorly in patients, casting dou bt on the routine use of myocardial scintigraphy for screening TxCAD.