title: Coronary flow reserve by transthoracic echocardiography predicts epicardial intimal thickening in cardiac allograft vasculopathy.
abstract: Cardiac allograft vasculopathy (CAV) is the leading cause of morbidity and mortality in heart transplantation (HT). We sought to investigate the role of coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in CAV diagnosis. CAV was defined as maximal intimal thickness (MIT) assessed by intravascular ultrasound (IVUS) > or =0.5 mm. CFR was assessed in the left anterior descending coronary artery in 22 HT recipients at 6 +/- 4 years post-HT. CAV was diagnosed in 10 patients (group A), 12 had normal coronaries (group B). The mean MIT was 0.7 +/- 0.1 mm (range 0.03-1.8). MIT was higher in group A (1.16 +/- 0.3 mm vs. 0.34 +/- 0.07 mm, p < 0.0001). CFR was 3.1 +/- 0.8 in all patients and lower in group A (2.5 +/- 0.6 vs. 3.7 +/- 0.3, p < 0.0001). CFR was inversely related with MIT (r =-0.774, p < 0.0001). A cut point of < or =2.9, identified as optimal by receiver operating characteristics analysis was 100% specific and 80% sensitive (PPV = 100%, NPV = 89%, Accuracy = 91%). CFR assessment by CE-TTE is a novel noninvasive diagnostic tool in the detection of CAV defined as MIT > or =0.5 mm. CFR by CE-TTE may reduce the need for routine IVUS in HT.
authors.affiliation: Department of Cardiology, University of Padova, Italy. francescotona@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Tona
authors.forename: E
authors.initials: E
authors.lastname: Osto
authors.forename: G
authors.initials: G
authors.lastname: Tarantini
authors.forename: A
authors.initials: A
authors.lastname: Gambino
authors.forename: F
authors.initials: F
authors.lastname: Cavallin
authors.forename: G
authors.initials: G
authors.lastname: Feltrin
authors.forename: R
authors.initials: R
authors.lastname: Montisci
authors.forename: A L P
authors.initials: AL
authors.lastname: Caforio
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*; D003326:Coronary Circulation / Q000502:physiology*; D004359:Drug Therapy, Combination; D004452:Echocardiography; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology* / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents