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European Heart Journal 2001 22(11):964-971; doi:10.1053/euhj.2000.2422
Copyright © 2001 by the European Society of Cardiology.
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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

G.R Cilibertoa,f1, L Ruffinib, M Mangiavacchia, M Parolinic, R Sarab, D Massaa, R De Mariac, E Grondaa, E Vitalia and O Parodic

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.

References

  1. Kaye MP. The registry of the international society for heart and lung transplantation ninth official report—1992. J Heart Lung Tranplant. 1992;11:599–606[ISI][Medline]
  2. Eich D, Thompson J, Ko D. Hypercholesterolemia in long-term survivors of heart transplantation: an early marker of accelerated coronary artery disease. J Heart Lung Transplant. 1991;10:45–49[ISI][Medline]
  3. Gao SZ, Alderman EL, Schroeder JS, Silverman JF, Hunt SA. Accelerated coronary vascular disease in heart transplant patients: coronary arteriographic findings. J Am Coll Cardiol. 1988;12:334–340[Abstract]
  4. Balk AH, Simoons ML, Van Den Linden MJ. Coronary artery disease after heart transplantation: timing of coronarry arteriography. J Heart Lung Transplant. 1993;12:89–99[ISI][Medline]
  5. Smart FW, Ballantyne CM, Cocanougher B. Insensitivity of noninvasive tests to detect coronary artery vasculopathy after heart transplant. Am J Cardiol. 1991;67:243–247[CrossRef][ISI][Medline]
  6. Collings CA, Pinto FJ, Valantine HA, Popylisen S, Puryear JV, Schnittiger I. Exercise echocardiography in heart transplant recipients: a comparison with angiography and intracoronary ultrasound. J Heart Lung Transplant. 1994;13:604–613[ISI][Medline]
  7. Cohn, JM, Wilensky, RL, O'Donnel, JA, Bourdillon, PDV, Dillon, JC, Feigenbaum, H, Exercise echocardiography, angiography, and intracoronary ultrasound after cardiac transplantation. Am J Cardiol, 1996, 77, 1216, 9
  8. Mairesse GH, Marwick TH, Melin JA. Use of exercise electrocardiography, technetium-99m-MIBI perfusion tomography, and two-dimensional echocardiography for coronary disease surveillance in a low-prevalence population of heart transplant recipients. J Heart Transplant. 1995;14:222–229
  9. Ciliberto GR, Mangiavacchi M, Banfi F. Coronary artery disease after heart transplantation: non-invasive evaluation with exercise thallium scintigraphy. Eur Heart J. 1993;14:226–229[Abstract/Free Full Text]
  10. Ciliberto GR, Massa D, Mangiavacchi M. High-dose dipyridamole echocardiography test in coronary artery disease after heart transplantation. Eur Heart J. 1993;14:48–52[Abstract/Free Full Text]
  11. Derumeaux G, Redonnet M, Mouton-Schleifer D. Dobutamine stress echocardiography in orthotopic heart transplant recipients. J Am Coll Cardiol. 1995;25:1665–1672[Abstract]
  12. Akosah KO, Mohanty PK. Role of dobutamine stress echocardiography in heart transplant recipients. Chest. 1998;113:809–815[Abstract/Free Full Text]
  13. Spes CH, Klauss V, Mudra SD. Role of dobutamine stress echocardiography for diagnosis of cardiac allograft vasculopathy. Transplant Proceeding. 1998;30:904–908
  14. Rodney RA, Johonson LL, Blood DK, Barr ML. Myocardial perfusion scintigraphy in heart transplant recipients with and without allograft atherosclerosis: a comparison of thallium-201 and technetium 99m Sestamibi. Heart Lung Transplant. 1994;13:173–180[ISI][Medline]
  15. J Heart Transplant. 1990;9:587–593[Medline]
  16. Schiller NB. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echo. 1980;2:359–367
  17. Parodi O, Marcassa C, Casucci R. Accuracy and safety of Technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile (sestamibi) myocardial scintigraphy with high dose dipyridamole test in patients with effort angina pectoris: a multicenter study. J Am Coll Cardiol. 1991;18:1439–1444[Abstract]
  18. St. Goar FG, Pinto FJ, Alderman EL. Intracoronary ultrasound in cardiac transplant recipients. In vivo evidence of ‘angiographically silent’ intimal thickening. Circulation. 1992;85:979–987[Abstract/Free Full Text]
  19. Mehra MR, Ventura HO, Stapleton DD, Smart FW, Collins TC, Ramee SR. Presence of severe intimal thickening by intravascular ultrasound predicts cardiac events in cardiac allograft vasculopathy. J Heart Lung Transplant. 1995;14:632–639[ISI][Medline]
  20. Fang JC, Rocco T, Jarcho J, Ganz P, Mudge GH. Noninvasive assessment of transplant-associated arteriosclerosis. Am Heart J. 1998;134:980–987
  21. Barbir M, Lazem F, Banner N, Mitchell A, Yacoub M. The prognostic significance of non-invasive cardiac tests in heart transplant recipients. Eur Heart J. 1997;18:692–696[Abstract/Free Full Text]
  22. Verhoeven PAM, Lee FA, Ramahi TM. Prognostic value of noninvasive testing one year after orthotopic cardiac transplantation. J Am Coll Cardiol. 1996;28:183–189[Abstract]
  23. Deremeaux G, Redonnet M, Soyer R, Cribier A, Letac B. Assessment of the progression of cardiac allograft vasculopathy by dobutamine stress echocardiography. J Heart Lung Transplant. 1998;17:259–267[ISI][Medline]
  24. Sooudi SK, MacLellan RW, Vardan S, Durand JB, Farmer JA, Verani MS. Comparison of dobutamine echocardiography and Thallium SPECT with coronary angiography to predict cardiac events in asymptomatic heart transplant recipients (Abstr). Circulation. 1998;98:I-185
  25. Spes HC, Klauss V, Mudra H, Schnaack. Diagnostic and prognostic value of serial dobutamine stress echocardiography for noninvasive assessment of cardiac allograft vasculopathy. Comparison with coronary angiography and intravascular ultrasound. Circulation. 1999;100:509–515[Abstract/Free Full Text]
  26. Hoffmann R, Lethen H, Marwick T. Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms. J Am Coll Cardiol. 1996;17:330–336
  27. Rechavia E, Araujo LI, De Silva R. Dipyridamole vasodilator response after human orthotopic heart transplantation: quantification by oxygen-15-labeled water and positron emission tomography. J Am Coll Cardiol. 1992;19:100–106[Abstract]
  28. Sennef MJ, Hartman J, Sobel BE, Geltman EM, Bergmann SR. Persistence of coronary vasodilator responsivity after cardiac transplantation. Am J Cardiol. 1993;71:333–338[CrossRef][ISI][Medline]
  29. Pouillart F, Levy M, Amrein C. Intèret de la tomoscintigraphie myocardique double isotope dans la détection de la maladie coronaire du greffon chez 96 transplantés cardiaques. Arch Mal Coeur. 1999;92:235–241

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