Prognostic value of contractile response during high-dose dipyridamole echocardiography test in heart transplant recipients.
BACKGROUND
Coronary allograft vasculopathy (CAV) remains a main factor limiting long-term survival after heart transplantation (HTX). The diagnosis of CAV is still based on serial coronary angiography. In this study, we evaluated the prognostic value of high-dose dipyridamole echocardiography in HTX.


METHODS
Sixty-eight patients underwent dipyridamole echocardiography within 48 hours of their scheduled annual coronary angiography. Coronary allograft vasculopathy was defined as CAV 1 (focal or diffuse stenosis <50%) or CAV 2 (focal or diffuse stenosis >or=50%). Wall-motion score index (WMSI) was evaluated at rest and after dipyridamole administration.


RESULTS
Results of coronary angiography were normal in 43 patients (63%), showed CAV 1 in 11 (16%), and showed CAV 2 in 14 (21%). Rest wall motion was normal in 39 patients and abnormal in 29. After dipyridamole administration, wall motion remained normal in all 39 (Group 1, no CAV in 34 and CAV 1 in 5). Of 29 patients with rest wall-motion abnormalities, all reversed to normal after dipyridamole in 8 patients (Group 2, no CAV in 7 and CAV 1 in 1) and remained or worsened in 21 (Group 3, CAV 2 in 14 and no CAV or CAV 1 in 7). During follow-up (6 +/- 3 years), 15 patients had major cardiac events: 11 occurred in Group 3, whereas 4 occurred in Groups 1 and 2. Wall motion at rest and after dipyridamole administration and CAV were independent predictors for cardiac events; only dipyridamole WMSI >1 remained significant (p < 0.0001) at multivariate analysis.


CONCLUSIONS
Dipyridamole echocardiography is a simple, non-invasive test that after HTX may identify patients with altered wall motion who deserve stricter surveillance.
Cardiothoracovascular Department A. De Gasperis, Milan, Italy
Guglielma Rita
GR
Ciliberto
Oberdan
O
Parodi
Gabriella
G
Cataldo
Maurizio
M
Mangiavacchi
Antonia
A
Alberti
Marina
M
Parolini
Maria
M
Frigerio
D000328:Adult; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D004176:Dipyridamole / Q000494:pharmacology*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D011379:Prognosis; D014665:Vasodilator Agents / Q000494:pharmacology
D014665:Vasodilator Agents; D004176:Dipyridamole