Dobutamine stress echocardiography in orthotopic heart transplant recipients. VACOMED Research Group.
OBJECTIVE
This study sought to determine whether dobutamine stress echocardiography could accurately identify coronary artery disease after heart transplantation.


BACKGROUND
After heart transplantation, coronary artery disease is related to either diffuse concentric intimal thickening or focal stenosis and may be underdiagnosed by coronary angiography.


METHODS
We enrolled 41 patients, a mean (+/- SD) of 40 +/- 20 months after heart transplantation, at the time of their routine control coronary angiogram. Three patients were excluded because of poor echogenicity on the angiogram and one because of ventricular premature beats. Standard echocardiographic views were acquired at baseline and at incremental dobutamine infusion levels (from 5 to a maximal dose of 40 micrograms/kg body weight per min at 3-min intervals). Regional wall motion score was calculated from a 16-segment model, and each segment was graded from 1 (normal) to 4 (dyskinesia). Coronary angiography was performed 24 h after dobutamine stress echocardiography, and angiograms were analyzed in blinded manner.


RESULTS
Twenty-three (62%) of 37 patients had normal coronary angiographic findings. Dobutamine stress echocardiography showed abnormalities in only 2 of 23 patients. Fourteen patients (38%) had abnormal angiographic findings, seven of whom had stenoses > 50%. Dobutamine stress echocardiography correctly identified the corresponding hypoperfused segments in these seven patients. More of interest were the other seven patients, of whom three had angiographic nonsignificant stenoses (< 50%), and four had minor diffuse coronary irregularities. Dobutamine stress echocardiography showed hypokinesia in five of these seven patients despite nonsignificant lesions at coronary angiography. The respective overall sensitivity and specificity of dobutamine stress echocardiography were 86% and 91%. At follow-up, 2 of the 37 patients had an acute myocardial infarction. Both had abnormal findings on dobutamine stress echocardiography: One had normal coronary angiographic results, and one had significant coronary lesions.


CONCLUSIONS
Dobutamine stress echocardiography is a useful technique for the diagnosis of coronary artery disease after heart transplantation. These preliminary results indicate that dobutamine stress echocardiography may have a predictive value for further ischemic events in heart transplant recipients.
Derumeaux
G
G
Service de Cardiologie, Hôpital Charles Nicolle, Centre Hôpitalier et Universitaire de Rouen, France.
Redonnet
M
M
Mouton-Schleifer
D
D
Bessou
J P
JP
Cribier
A
A
Saoudi
N
N
Koning
R
R
Soyer
R
R
Letac
B
B
D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D005080:Exercise Test; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D004280:Dobutamine