title: Dobutamine stress echocardiography predicts cardiac events or death in asymptomatic patients long-term after heart transplantation: 4-year prospective evaluation.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) remains the major cause of death after cardiac transplantation during long-term follow-up. Nevertheless, annual angiographic evaluation is difficult to perform routinely. We evaluated the value of clinical risk factors and non-invasive testing for cardiac allograft vasculopathy in predicting cardiac events or death in asymptomatic patients with normal ventricular function during long-term follow-up after heart transplantation.
  
  
  METHODS
  We studied 39 patients, mean aged 48 +/- 13 years, at 86 +/- 31 months after heart transplantation. Patients underwent thallium scintigraphy, treadmill stress testing, dobutamine stress echocardiography, and angiography to detect CAV. We prospectively observed all patients an additional 4 years for acute myocardial infarction, congestive heart failure, or death.
  
  
  RESULTS
  Angiography detected CAV in 15 patients (38%). Three patients had acute myocardial infarction and another 7 had congestive heart failure, representing 25% of cardiac events during the study period. Nine deaths (23%) occurred during the same observation time. Univariate analysis showed that increased body mass index, positive dobutamine stress echocardiography results, and positive angiography results were associated significantly with cardiac events or death during follow-up. In the absence of coronary angiography, stepwise logistic regression identified positive dobutamine echocardiography results as the unique independent predictor of cardiac events (p = 0.001) or death (p = 0.002).
  
  
  CONCLUSIONS
  Cardiac events and death after heart transplantation increased during long-term follow-up of this population. However, dobutamine stress echocardiography is well tolerated and, in the absence of routine angiographic evaluation, may be a strong predictor of these events.
authors.affiliation: Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil. fbacal@uol.com.br
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: Luizfelipe
authors.initials: L
authors.lastname: Moreira
authors.forename: Germano
authors.initials: G
authors.lastname: Souza
authors.forename: Ana Clara
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: Alfredo
authors.initials: A
authors.lastname: Fiorelli
authors.forename: Noedir
authors.initials: N
authors.lastname: Stolf
authors.forename: Edimar
authors.initials: E
authors.lastname: Bocchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bellotti
authors.forename: José Antonio F
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D004280:Dobutamine