title: Follow-up of heart transplant recipients with serial echocardiographic coronary flow reserve and dobutamine stress echocardiography to detect cardiac allograft vasculopathy.
abstract: BACKGROUND
  Implementation of reliable noninvasive testing for screening cardiac allograft vasculopathy (CAV) is of critical importance. The most widely used modality, dobutamine stress echocardiography (DSE), has moderate sensitivity and specificity. The aim of this study was to assess the potential role of serial coronary flow reserve (CFR) assessment together with DSE for predicting CAV.
  
  
  METHODS
  A total of 90 studies were performed prospectively over 5 years in 23 consecutive heart transplant recipients who survived >1 year after transplantation. Assessment of CFR with transthoracic Doppler echocardiography, DSE, coronary angiography, and endomyocardial biopsy was performed annually. Results of CFR assessment and DSE were compared with angiographic findings of CAV.
  
  
  RESULTS
  Acute cellular rejections were excluded by endomyocardial biopsies. CAV was detected in 17 of 90 angiograms. Mean CFR was similarly lower in both mild (CAV grade 1) and more severe (CAV grades 2 and 3) vasculopathy, but wall motion score index became higher in parallel with increasing grades of vasculopathy. Any CAV by angiography was detected either simultaneously with or later than CFR impairment, yielding 100% sensitivity for CFR. The combination of CFR and DSE increased the specificity of the latter from 64.3% to 87.2% without compromising sensitivity (77.8%).
  
  
  CONCLUSIONS
  CFR is very sensitive for detecting CAV and increases the diagnostic accuracy of DSE, raising the potential for patient management tailored to risk modification and to avoid unnecessary angiographic procedures.
authors.affiliation: Department of Cardiology, University of Baskent Faculty of Medicine, Ankara, Turkey. Electronic address: elifsade@baskent-ank.edu.tr.
authors.forename: Leyla Elif
authors.initials: LE
authors.lastname: Sade
authors.affiliation: Department of Cardiology, University of Baskent Faculty of Medicine, Ankara, Turkey.
authors.forename: Serpil
authors.initials: S
authors.lastname: Eroğlu
authors.affiliation: Department of Preventive Oncology and Epidemiology, University of Hacettepe Cancer Institute, Ankara, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Yüce
authors.affiliation: Department of Cardiology, University of Baskent Faculty of Medicine, Ankara, Turkey.
authors.forename: Aslı
authors.initials: A
authors.lastname: Bircan
authors.affiliation: Department of Cardiology, University of Baskent Faculty of Medicine, Ankara, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Pirat
authors.affiliation: Department of Cardiovascular Surgery, University of Baskent Faculty of Medicine, Ankara, Turkey.
authors.forename: Atilla
authors.initials: A
authors.lastname: Sezgin
authors.affiliation: Department of Cardiology, University of Baskent Faculty of Medicine, Ankara, Turkey.
authors.forename: Alp
authors.initials: A
authors.lastname: Aydınalp
authors.affiliation: Department of Cardiology, University of Baskent Faculty of Medicine, Ankara, Turkey.
authors.forename: Haldun
authors.initials: H
authors.lastname: Müderrisoğlu
mesh_terms: D000328:Adult; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000209:etiology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Allograft vasculopathy; Coronary flow; Dobutamine stress echocardiography; Heart transplant