Allograft VasculopathyAccuracy of dobutamine tetrofosmin myocardial perfusion imaging for the noninvasive diagnosis of transplant coronary artery stenosis☆
Section snippets
Patient selection
The study population consisted of 50 recipients of cardiac allograft who underwent dobutamine stress 99m technetium tetrofosmin SPECT at a mean of 6.4 ± 2.8 (range 2–14) years after the transplantation and coronary angiography within 3 months from the dobutamine stress test. Mean age was 56 ± 8 years. There were 45 men and 5 women. Two patients had atypical chest pain. Risk factors for CAD were hypertension in 32 (64%) patients, diabetes mellitus in 5 (10%) patients, smoking in 6 (12%) patients
Dobutamine stress test
There was a significant increase of heart rate (93 ± 11 vs 142 ± 9 beats/minute, p < 0.0001), systolic blood pressure (144 ± 19 vs 151 ± 28 mm Hg, p < 0.01) and rate pressure product (13516 ± 3026 vs 21365 ± 4114, p < 0.0001) from rest to peak stress respectively. Two patients developed atypical and one patient developed typical chest pain during stress. The target heart rate (≥85% of the maximal exercise heart rate predicted for age) was reached in 41 patients (82%). Minor side effects were
Discussion
This is the first study, which evaluates the accuracy of dobutamine myocardial perfusion imaging for the non-invasive diagnosis of TCAS. Our data showed that dobutamine tetrofosmin myocardial perfusion SPECT imaging is a highly sensitive methods for the diagnosis of significant TCAS in patients studied 6.4 ± 2.8 (range 2–14) years after heart transplantation. Myocardial perfusion abnormalities were detected in 90% of patients with TCAS. The high sensitivity was shown in patients with single
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Emerging imaging techniques after cardiac transplantation
2016, Journal of Heart and Lung TransplantationCardiac Transplantation: Pretransplant and Posttransplant Evaluation
2016, Practice of Clinical EchocardiographyImaging for coronary allograft vasculopathy in children and adolescents
2014, Progress in Pediatric CardiologyDetection and imaging of cardiac allograft vasculopathy
2013, JACC: Cardiovascular ImagingTransplant coronary artery disease
2010, JACC: Cardiovascular InterventionsThe Role of Multimodality Cardiac Imaging in the Transplanted Heart
2009, JACC: Cardiovascular ImagingCitation Excerpt :Moreover, the use of vasodilators with MPI may be limited in cardiac transplant recipients because the diffuse, microvascular CAV may impair the necessary increase in coronary flow reserve to trigger the flow heterogeneity to detect significant stenosis. Despite these observations, more recent studies using dipyridamole MPI have demonstrated comparable sensitivity (range 80% to 92%) and specificity (range 86% to 92%) to dobutamine stress MPI to detect CAV (46,52–54). Similar to DSE, the potential clinical usefulness of SPECT-MPI relates to its prognostic value.
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This study was supported in part by the Department of Cardiology, Cairo University Hospital, Cairo, Egypt.