title: Dobutamine stress echocardiography in the assessment of cardiac allograft vasculopathy in asymptomatic recipients.
abstract: OBJECTIVE
  Cardiac allograft vasculopathy (CAV) is the most important cause of late mortality among cardiac allograft recipients. Dobutamine stress echocardiography (DSE) is considered a safe and cost-effective method to screen these patients who remain free of angina most of the time. We evaluated DSE results in a series of cardiac allograft recipients.
  
  
  METHODS
  The DSE was performed on a yearly basis. From 2004 to 2006, twelve DSEs were performed on 8 patients, including 7 men, and overall mean age of 36 +/- 12 years. Dobutamine infusion begun at 5 microg/kg/min was titrated at 3-minute stages to 10, 20, 40, and 50 microg/kg/min to achieve the target heart rate. In addition, at every stage, we performed a 12-lead EKG, heart rate, and blood pressure recording. The DSE results were compared with coronary angiograms and endomyocardial biopsies.
  
  
  RESULTS
  Two patients displayed mildly and 1 patient a severely abnormal DSE test. The severely abnormal DSE test was associated with severe coronary artery stenosis, including inexperiment of the left main coronary artery. The second patient with an abnormal DSE had contour irregularities and distal cut-off of the right coronary artery as well as 2R cellular rejection. The third patient had a normal angiogram and no rejection. None of the patients with normal DSE experienced a cardiac event, coronary lesions, or rejection.
  
  
  CONCLUSIONS
  Use of DSE appears to be a sensitive method to detect CAV in asymptomatic recipients. However, mild wall motion abnormalities can be detected in patients without stenosing coronary lesions. The value of DSE in predicting CAV must be examined in larger series with long-terms of follow-up.
authors.affiliation: Department of Cardiovascular Surgery, University of Başkent, Faculty of Medicine, Ankara, Turkey. sadele@gmail.com
authors.forename: L Elif
authors.initials: LE
authors.lastname: Sade
authors.forename: A
authors.initials: A
authors.lastname: Sezgin
authors.forename: S
authors.initials: S
authors.lastname: Eroğlu
authors.forename: H
authors.initials: H
authors.lastname: Bozbaş
authors.forename: M
authors.initials: M
authors.lastname: Uluçam
authors.forename: H
authors.initials: H
authors.lastname: Müderrisoğlu
mesh_terms: D001706:Biopsy; D025401:Echocardiography, Stress; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000473:pathology / Q000502:physiology*; D006801:Humans; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000473:pathology; D013997:Time Factors; D014184:Transplantation, Homologous