Copyright © 2001 by the European Society of Cardiology.
Resting echocardiography and quantitative dipyridamole technetium-99m sestamibi tomography in the identification of cardiac allograft vasculopathy and the prediction of long-term prognosis after heart transplantation
a Department of Cardiology A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy
b Nuclear Medicine Service, Niguarda Ca' Granda Hospital, Milan, Italy
c CNR Clinical Physiology Institute of Pisa, Section of Milan, Niguarda Ca' Granda Hospital, Milan, Italy
Received June 4, 2000; accepted August 16, 2000
Abstract
Aims To evaluate the accuracy of echocardiography in conjunction with quantitative high-dose dipyridamole technetium-99m sestamibi tomography (SPECT) in detecting coronary allograft vasculopathy.
Methods and Results Seventy-eight consecutive heart transplant recipients underwent echocardiography while at rest and high-dose dipyridamole SPECT within 48h of a yearly angiogram. Resting wall motion abnormalities were considered significant if present in two or more segments. SPECT was considered abnormal in the presence of reversible/fixed defects. The coronary angiogram was normal in 53, showed non-significant coronary allograft vasculopathy in 13 and significant (
50% stenosis) coronary allograft vasculopathy in 12 cases. Resting wall motion abnormalities were observed in nine cases and perfusion defects in 20. Echocardiography and SPECT were concordant in 59 cases (five positive and 54 negative); in these, accuracy was 100% for significant coronary allograft vasculopathy and 83% for any coronary allograft vasculopathy. Over 6·5±2 years, 17 patients suffered coronary allograft vasculopathy-related events, including death in six and retransplantation in three. Resting wall motion abnormalities, SPECT perfusion defects and angiographic coronary allograft vasculopathy were significant predictors of cardiac events.
Conclusion Normal resting wall motion at echocardiography coupled to normal stress myocardial perfusion, rules out the presence of significant coronary allograft vasculopathy in many heart transplant recipients. Conversely, resting wall motion abnormalities and perfusion defects strongly predict cardiac events. Therefore, a strategy which reserves angiography for patients with resting wall motion abnormalities and/or perfusion defects may be safe and cost-effective.
Key Words: Heart transplantation, echocardiography, perfusion imaging, prognosis
f1 Correspondence: Guglielma R. Ciliberto, MD, Viale Romagna 56/3, 20123 Milan, Italy.
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