title: The pressure/volume relationship during dobutamine stress echocardiography in transplanted heart: comparison with quality of life and coronary anatomy.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) is a major late complication in cardiac transplant recipients and has a relevant impact on outcome of these patients.
  
  
  OBJECTIVE
  to compare, in cardiac transplant recipients patients, the diagnostic value of pressure/volume relationship (ESPVR) during dobutamine stress echocardiography (DSE) for coronary artery disease, assessed by Multislice Computed Tomography (MSCT), and by coronary angiography (CA). We also analyzed any possible relationship between ESPVR and the Health Related Quality of Life of the patients (HRQoL), evaluated by SF-36 questionnaire.
  
  
  METHODS
  25 consecutive patients underwent DSE within 24 hours after MSCT coronary angiogram and then they underwent CA. The HRQoL questionnaire was administered to the patients in the settings of DSE. They were followed-up for 6 months.
  
  
  RESULTS
  DSE has a sensitivity in detecting CAV of 67%, specificity of 95%, positive predictive value of 67% and negative predictive value of 95%; DSE with ESPVR has a sensitivity of 100%, specificity of 95%, positive predictive value of 75%, negative predictive value of 100%; MSCT has a sensitivity of 100%; specificity of 82%; positive predictive value of 43%; negative predictive value of 100%. Htx recipients with a flat-biphasic ESPVR, although asymptomatic, perceived a worst HRQoL compared with the up-sloping ESPVR population, and this is statistically significant for the general health (p 0.0004), the vitality (p 0.0013) and the mental health (p 0.021) SF-36 subscale.
  
  
  CONCLUSIONS
  Evaluation with DSE and ESPVR is accurate in the clinical control of heart transplant recipients reserving invasive evaluation only for patients with abnormal contractility indexes.
authors.affiliation: Department of Cardiovascular Science, Heart Transplant Center, S, Camillo-Forlanini Hospital, Circonvallazione Gianicolense, 87, Rome, 00151, Italy. giordano.zampi@alice.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minardi
authors.forename: Giordano
authors.initials: G
authors.lastname: Zampi
authors.forename: Amedeo
authors.initials: A
authors.lastname: Pergolini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Scappaticci
authors.forename: Francesca Moschella
authors.initials: FM
authors.lastname: Orsini
authors.forename: Gaetano
authors.initials: G
authors.lastname: Pero
authors.forename: Paola Lilla Della
authors.initials: PL
authors.lastname: Monica
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D015331:Cohort Studies; D017023:Coronary Angiography; D025401:Echocardiography, Stress; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left / Q000502:physiology