Utility of exercise stress echocardiography in pediatric cardiac transplant recipients: a single-center experience.
BACKGROUND
Annual coronary angiography (ANG) to assess for significant epicardial coronary artery disease (CAD) is an integral part of follow-up care for pediatric cardiac transplant recipients at Children's Hospital Boston. Exercise stress echocardiography (ESE) is an important, non-invasive tool for the detection of ischemia in adults but has been rarely used in children. Therefore, the aim of this study was to assess the feasibility and utility of ESE in excluding ANG-detected epicardial CAD at our center, where ESE has been implemented since 2007.


METHODS
We conducted a retrospective review of all pediatric cardiac transplant recipients at our institution who had undergone ESE and ANG between January 2007 and December 2010, and with testing performed < 12 months apart. ESE results were compared against ANG.


RESULTS
The study cohort comprised 47 cardiac transplant recipients. One patient's ESE images were inadequate for interpretation. Of the remaining 46 patients, ESE had a sensitivity of 88.9% (95% confidence limits [CL], 51.8%, 99.7%), a specificity of 91.9% (95% CL, 71.8%, 98.3%), and a negative predictive value of 97% (95% CL, 85.1%, 99.1%) for the ANG-detected CAD.


CONCLUSIONS
This large, single-center study showed ESE was feasible and had a high specificity and excellent negative predictive value in excluding epicardial CAD in pediatric cardiac transplant recipients. Future prospective, large-scale studies are needed to confirm these findings and help identify a subset of children for whom a negative ESE could decrease the frequency of routine ANG.
Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA. minghui.chen@cardio.chboston.org
Ming Hui
MH
Chen
Elizabeth
E
Abernathey
Fatima
F
Lunze
Steven D
SD
Colan
Stephen
S
O'Neill
Lisa
L
Bergersen
Tal
T
Geva
Elizabeth D
ED
Blume
D000293:Adolescent; D000328:Adult; D001900:Boston; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D025401:Echocardiography, Stress; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014180:Transplantation; D055815:Young Adult