[Value of dobutamine echocardiography in the detection of coronary disease in heart transplant patient. Groupe de Recherche VACOMED].
The value of Dobutamine stress echocardiography in the detection of coronary artery disease in heart transplant patients was studied in 64 patients at control coronary angiography 39 +/- 14 months after transplantation. Dobutamine was infused at progressively increasing doses (5 to 40 micrograms/kg/min) at 5 minute intervals, in order to reach 85% of the theoretical maximal heart rate or an ischaemic event. Echocardiography was analysed in the 4 standard views which were digitised allowing calculation of a regional wall motion score under basal conditions and at peak dosage in 16 left ventricular segments. Coronary angiography identified three groups: group I: 29 patients with normal coronary arteries; group II: 17 patients with non-significant coronary disease (diffuse or localised stenosis < 50%); group III: 9 patients with significant (> 50%) coronary disease. Dobutamine stress echocardiography showed regional wall motion abnormalities in 2/29 patients in group I, 13/17 patients in group II and all patients in group III (global sensitivity: 85%; specificity: 97%). The contractility score was significantly higher under basal conditions in group III (1.45 +/- 0.54) than in group I (1) and group II (1.17 +/- 0.23). At peak dose, the contractility score was unchanged in group I and increased significantly (p < 0.01) in the other two groups. The authors conclude that Dobutamine echocardiography is a reliable, non-invasive method of detecting coronary disease in cardiac transplant patients, and is particularly valuable for demonstrating myocardial ischaemia related to coronary lesions judged to be not significant at coronary angiography.
Derumeaux
G
G
Service de cardiologie, Hôpital Charles Nicolle, Houen.
Redonnet
M
M
Mouton-Schleifer
D
D
Cribier
A
A
Soyer
R
R
Letac
B
B
D000328:Adult; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D004280:Dobutamine
Apport de l'échocardiographie sous dobutamine dans la détection de la maladie coronaire du transplanté cardiaque. Groupe de Recherche VACOMED.