title: Noninvasive diagnosis of allograft vascular disease after heart transplantation.
abstract: OBJECTIVE
  To determine the predictive values of noninvasive tests for the detection of allograft vascular disease.
  
  
  METHODS
  We studied 39 patients with mean ages of 48+/-13 years and a follow-up period of 86+/-13 months. The diagnosis of allograft vascular disease was made by cine-coronary arteriography, and it was considered as positive if lesions existed that caused > or =50% obstruction of the lumen. Patients underwent 24h Holter monitoring, thallium scintigraphy, a treadmill stress test, and dobutamine stress echocardiography. Sensitivity, specificity, and positive and negative predictive values were determined in percentages for each method, as compared with the cine-coronary arteriography results.
  
  
  RESULTS
  Allograft vascular disease was found in 15 (38%) patients. The Holter test showed 15.4% sensitivity, 95.5% specificity. For the treadmill stress test, sensitivity was 10%, specificity was 100%. When thallium scintigraphy was used, sensitivity was 40%, specificity 95.8%. On echocardiography with dobutamine, we found a 63.6% sensitivity, 91.3% specificity. When the dobutamine echocardiogram was associated with scintigraphy, sensitivity was 71.4%, specificity was 87%.
  
  
  CONCLUSIONS
  In this group of patients, the combination of two noninvasive methods (dobutamine echocardiography and thallium scintigraphy) may be a good alternative for the detection of allograft vascular disease in asymptomatic patients with normal ventricular function.
authors.affiliation: Instituto do Coração do Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, 05403-000, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Bacal
authors.forename: N A
authors.initials: NA
authors.lastname: Stolf
authors.forename: V C
authors.initials: VC
authors.lastname: Veiga
authors.forename: W A
authors.initials: WA
authors.lastname: Chalela
authors.forename: C
authors.initials: C
authors.lastname: Grupi
authors.forename: A C
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: E E
authors.initials: EE
authors.lastname: Martinez
authors.forename: A I
authors.initials: AI
authors.lastname: Fiorelli
authors.forename: L F
authors.initials: LF
authors.lastname: Moreira
authors.forename: E A
authors.initials: EA
authors.lastname: Bocchi
authors.forename: G
authors.initials: G
authors.lastname: Bellotti
authors.forename: J A
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D011875:Radionuclide Angiography; D012680:Sensitivity and Specificity; D014184:Transplantation, Homologous