[Initial experiences with dobutamine stress echocardiography in heart transplant patients].
Cardiac allograft vasculopathy (CAV) has become one of the primary obstacles to long-term survival of patients after heart transplantation. The low sensitivity of currently available noninvasive tests still remains a problem in the early diagnosis of the disease. To assess the feasibility, safety, and usefulness of dobutamine stress echocardiography as a noninvasive predictor of cardiac allograft vasculopathy, we examined 20 patients (3 female) 3-35 months after orthotopic heart transplantation. All patients underwent coronary angiography within 2 weeks of dobutamine stress echocardiography.


RESULTS
89% of the segments examined could be evaluated for wall motion abnormalities. Under increasing doses of dobutamine (5 to max. 30 micrograms/kg/min), heart rate increased from 88 +/- 13 bpm to 141 +/- 16 bpm. and systolic blood pressure from 139 +2- 14 mm Hg to 154 +/- 28 mm Hg. Two of 4 patients with angiographically detected CAV developed new wall motion abnormalities under dobutamine; their wall motion score increased from 1.23 +/- 0.22 to 1.31 +/- 0.24. In the other patients without CAV, the wall motion score remained almost unchanged (1.01 +/- 0.3 to 1.02 +/- 0.4). Dobutamine was well tolerated, and there were no serious complications. Thus, dobutamine stress echocardiography seems to be feasible and safe in patients after heart transplantation. Our results suggest that it might be useful for the detection of cardiac allograft vasculopathy. The final determination of its clinical usefulness in the diagnosis of cardiac allograft vasculopathy needs further extensive investigations.
Günther
F
F
Medizinische Klinik und Poliklinik, Innere Medizin C, Münster.
Schwammenthal
E
E
Rahmel
A
A
Lamp
B
B
Kerber
S
S
Deng
M
M
Scheld
H H
HH
Breithardt
G
G
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004280:Dobutamine; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography / Q000187:drug effects; D015716:Electrocardiography, Ambulatory / Q000187:drug effects; D005080:Exercise Test / Q000187:drug effects; D005240:Feasibility Studies; D005260:Female; D016027:Heart Transplantation / Q000502:physiology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology
D004280:Dobutamine
Erste Erfahrungen mit der Dobutamin-Belastungsechokardiographie bei herztransplantierten Patienten.