Resting echocardiography and quantitative dipyridamole technetium-99m sestamibi tomography in the identification of cardiac allograft vasculopathy and the prediction of long-term prognosis after heart transplantation.
OBJECTIVE
To evaluate the accuracy of echocardiography in conjunction with quantitative high-dose dipyridamole technetium-99m sestamibi tomography (SPECT) in detecting coronary allograft vasculopathy.


RESULTS
Seventy-eight consecutive heart transplant recipients underwent echocardiography while at rest and high-dose dipyridamole SPECT within 48 h of a yearly angiogram. Resting wall motion abnormalities were considered significant if present in two or more segments. SPECT was considered abnormal in the presence of reversible/fixed defects. The coronary angiogram was normal in 53, showed non-significant coronary allograft vasculopathy in 13 and significant (> or = 50% stenosis) coronary allograft vasculopathy in 12 cases. Resting wall motion abnormalities were observed in nine cases and perfusion defects in 20. Echocardiography and SPECT were concordant in 59 cases (five positive and 54 negative); in these, accuracy was 100% for significant coronary allograft vasculopathy and 83% for any coronary allograft vasculopathy. Over 6.5+/-2 years, 17 patients suffered coronary allograft vasculopathy-related events, including death in six and retransplantation in three. Resting wall motion abnormalities, SPECT perfusion defects and angiographic coronary allograft vasculopathy were significant predictors of cardiac events.


CONCLUSIONS
Normal resting wall motion at echocardiography coupled to normal stress myocardial perfusion, rules out the presence of significant coronary allograft vasculopathy in many heart transplant recipients. Conversely, resting wall motion abnormalities and perfusion defects strongly predict cardiac events. Therefore, a strategy which reserves angiography for patients with resting wall motion abnormalities and/or perfusion defects may be safe and cost-effective.
Ciliberto
G R
GR
Department of Cardiology A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy.
Ruffini
L
L
Mangiavacchi
M
M
Parolini
M
M
Sara
R
R
Massa
D
D
De Maria
R
R
Gronda
E
E
Vitali
E
E
Parodi
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000191:economics; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D004452:Echocardiography / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi / Q000191:economics; D013995:Time; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi