A prospective study of dobutamine stress echocardiography for the assessment of cardiac allograft vasculopathy in pediatric heart transplant recipients.
Transplant CAV is the leading cause of graft loss beyond one yr post-heart transplant. Diagnosis can be challenging and the previous "gold standard," coronary ANG, tends to underestimate disease. The purpose of this study was to relate DSE to ANG for the diagnosis of CAV. Prospective annual DSE at a single centre on all heart transplant patients (1999-2006) were compared with results from routine coronary angiograms. Progression of CAV over time as determined by DSE and ANG and associated factors were sought through logistic regression models adjusted for repeated measures. There were 102 heart transplant patients (54 males) transplanted between 1989 and 2006. Median age at transplant was 17 months (0-16.6 yr). The initial DSE was at a median of 10-months post-transplantation. There was a high correlation between an abnormal DSE and an abnormality on ANG (p = 0.002). There was an increased probability of an abnormal DSE with increasing grade of CAV as assessed by ANG (p < 0.001). Factors associated with an abnormal DSE included older age at transplant (p = 0.04), higher grade of rejection (p = 0.002), higher total cholesterol (p = 0.04), higher LDL (p < 0.05), and older age at the time of DSE (p = 0.002). DSE result was not related to HDL, triglyceride or homocysteine levels, or to steroid or statin use. The probability of an abnormal DSE result increases with increasing angiographic grade of CAV, and thus DSE may be used for initial screening for CAV with ANG reserved for confirmation and grading. Patients transplanted at an older age and those with a greater history of rejection were at higher risk of a positive DSE and may require increased surveillance for CAV.
Dipchand
Anne I
AI
Labatt Family Heart Centre, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON, Canada. anne.dipchand@sickkids.ca
Bharat
Winston
W
Manlhiot
Cedric
C
Safi
Mina
M
Lobach
Natalia E
NE
McCrindle
Brian W
BW
D000293:Adolescent; D002316:Cardiotonic Agents; D002648:Child; D002675:Child, Preschool; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D016027:Heart Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging* / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000379:methods; D011446:Prospective Studies; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology
D002316:Cardiotonic Agents; D004280:Dobutamine