title: Coronary flow reserve by contrast-enhanced echocardiography: a new noninvasive diagnostic tool for cardiac allograft vasculopathy.
abstract: Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50+/-12 years at HT), at 8+/-4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of <or=2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3+/-0.7 vs. 3.2+/-0.5, p<0.0001). The <or=2 cut point was 100% specific and 38% sensitive. The <or=2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard<or=2 cut point to 85% with the optimal cut point of <or=2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated.
authors.affiliation: Department of Cardiology, University of Padova, Padova, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tona
authors.forename: A L P
authors.initials: AL
authors.lastname: Caforio
authors.forename: R
authors.initials: R
authors.lastname: Montisci
authors.forename: A
authors.initials: A
authors.lastname: Angelini
authors.forename: M
authors.initials: M
authors.lastname: Ruscazio
authors.forename: A
authors.initials: A
authors.lastname: Gambino
authors.forename: A
authors.initials: A
authors.lastname: Ramondo
authors.forename: G
authors.initials: G
authors.lastname: Thiene
authors.forename: G
authors.initials: G
authors.lastname: Gerosa
authors.forename: S
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology*; D013997:Time Factors; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000473:pathology*