Non-invasive detection of coronary artery disease by dobutamine-stress echocardiography in children after heart transplantation.
BACKGROUND
Coronary vasculopathy is the main cause of cardiac graft failure. Because yearly coronary angiography is invasive in children, a non-invasive method for detecting graft vasculopathy is needed. The aim of this study was to test dobutamine-stress echocardiography in a pediatric population to determine its feasibility, safety and reliability in the detection of graft coronary artery disease.


METHODS
Eighteen patients, aged 2 days to 16.8 years at transplantation (mean 8.4 years), underwent 44 dobutamine-stress echocardiography (DSE) exams, at a follow-up of 1.1 to 11.8 years (mean 5.1 years). Selective coronary angiography was performed for comparison. Echocardiographic recordings were obtained in 4 standard views of the left ventricle and measurements carried out within the frames of a 16-segment model. Segmental scores of contractility were obtained for each segment and a total segmental contractility index was calculated at each stage.


RESULTS
All patients reached the maximum dose stage. Maximum heart rate was 57% to 90% of predicted maximum. Maximum systolic blood pressure reached 190 mmHg. Segmental scores were normal in 37 and abnormal in 7 cases. Echographic results were concordant with angiography in 82% and discordant in 18% of the cases (4 negative DSEs with minor angiographic lesions, 2 positive DSEs with normal angiography), but there was no significant angiographic lesion with normal DSE.


CONCLUSIONS
DSE is a safe and highly feasible non-invasive technique in transplanted children. A normal DSE study successfully predicts the absence of significant coronary artery disease in the post-transplant population.
Di Filippo
Sylvie
S
Department of Paediatric Cardiology, Hôpital Cardilogique Louis Pradel, Lyon, France. sylvie.di.filippo@wanadoo.fr
Semiond
Bertrand
B
Roriz
Ricardo
R
Sassolas
Francois
F
Raboisson
Marie José
MJ
Bozio
André
A
D000293:Adolescent; D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects; D025401:Echocardiography, Stress / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results
D002316:Cardiotonic Agents; D004280:Dobutamine