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
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.