Diagnosis of graft coronary artery disease.
OBJECTIVE
Graft coronary artery disease is the leading cardiac cause of death in patients who have undergone cardiac transplantation. Due to denervation, classic symptoms of angina are not reliable. Many transplant centers have a protocol of routine annual surveillance cardiac angiography because treatment options are limited, especially with advanced disease. Angiography is an assessment of the arterial lumen, however, and can miss nonfocal disease. This paper reviews invasive and noninvasive diagnostic tools for graft coronary artery disease. Intravascular ultrasound is the most sensitive, but the cost and lack of widespread expertise make it unpopular. Noninvasive techniques have been studied. An ideal test would be sufficiently sensitive to detect disease and allow for prognostic information. Dobutamine echocardiography is the most sensitive noninvasive test but can have a high false-positive rate. It is also not universally available. Exercise nuclear imaging is specific and can be used as a confirmatory test in patients with positive dobutamine echocardiograms.


RESULTS
Computed tomographic imaging and cardiac magnetic resonance imaging are exciting new modalities but require further study.


CONCLUSIONS
There is no test sensitive and specific enough yet that can be confidently used to replace coronary angiography.
Kass
Malek
M
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Allan
Rebecca
R
Haddad
Haissam
H
D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000209:etiology; D025401:Echocardiography, Stress; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000209:etiology; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D008279:Magnetic Resonance Imaging; D011159:Population Surveillance; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional