Dobutamine stress echocardiography for assessing coronary artery disease after transplantation in children.
OBJECTIVE
The purpose of this study was to determine the feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography (DSE) for evaluating posttransplant coronary artery disease (TxCAD) in children, and to determine the frequency of selected cardiac events after normal or abnormal DSE.


BACKGROUND
Posttransplant coronary artery disease is the most common cause of graft loss (late death or retransplantation) after cardiac transplantation (CTx) in children. Coronary angiography, routinely performed to screen for TxCAD, is an invasive procedure with limited sensitivity. The efficacy of DSE for detecting atherosclerotic coronary artery disease is established, but is unknown in children after CTx.


METHODS
Of the 78 children (median age 5.7 years, range 3 to 18) entered into the study, 72 (92%) underwent diagnostic DSE by means of a standard protocol, 4.6 +/- 1.9 years after CTx. The results of coronary angiography performed in 70 patients were compared with DSE findings. After DSE, subjects were monitored for TxCAD-related cardiac events, including death, retransplantation and new angiographic diagnosis of TxCAD.


RESULTS
No major complications occurred. Minor complications, most often hypertension, occurred in 11% of the 72 subjects. The sensitivity and specificity of DSE were 72% and 80%, respectively, when compared with coronary angiography. At follow-up (21 +/- 8 months), TxCAD-related cardiac events occurred in 2 of 50 children (4%) with negative DSE, versus 6 of 22 children (27%) with positive DSE (p < 0.01).


CONCLUSIONS
DSE is a feasible, safe and accurate screening method for TxCAD in children. Positive DSE identifies patients at increased risk of TxCAD-related cardiac events. Negative DSE predicts short-term freedom from such events.
Department of Pediatrics, Loma Linda University School of Medicine, California, USA. rllarsen@ccmail.llu.edu
R L
RL
Larsen
P M
PM
Applegate
D A
DA
Dyar
P A
PA
Ribeiro
S D
SD
Fritzsche
N F
NF
Mulla
G S
GS
Shirali
M A
MA
Kuhn
R E
RE
Chinnock
P M
PM
Shah
D000293:Adolescent; D000318:Adrenergic beta-Agonists; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D016757:Death, Sudden, Cardiac; D004280:Dobutamine; D004452:Echocardiography; D005240:Feasibility Studies; D005500:Follow-Up Studies; D005544:Forecasting; D006085:Graft Survival; D016027:Heart Transplantation / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D012086:Reoperation; D012307:Risk Factors; D012449:Safety; D012680:Sensitivity and Specificity
D000318:Adrenergic beta-Agonists; D004280:Dobutamine