Dobutamine stress echocardiography during follow-up surveillance in heart transplant patients: Diagnostic accuracy and predictors of outcomes

Chirakarnjanakorn, Srisakul; Starling, Randall C.; Popović, Zoran B.; Griffin, Brian P.; Desai, Milind Y.

doi:10.1016/j.healun.2014.11.019

Cited by 56 publications

(46 citation statements)

References 35 publications

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“…The data presented here, when combined with the recent Cleveland Clinic series 5 puts into question the external validity of the previous studies from nearly 20 years ago that established the evidence for DSE in CAV screening. This study found that DSE failed to diagnose CAV1 and CAV2 in the first five years following HT.…”

Section: Resultsmentioning

confidence: 60%

“…Previous studies reported a good sensitivity (72–95%) and specificity (55–91%) to detect luminal CAV 4 . A recent single center failed to replicate these findings among patients at least five years post-transplant, showing a sensitivity to detect CAV1-CAV3 of only 7–28% 5 . We sought to determine the adequacy of DSE for CAV assessment in the first five years after transplant.…”

Section: Introductionmentioning

confidence: 98%

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Dobutamine stress echocardiography is inadequate to detect early cardiac allograft vasculopathy

Clerkin

Farr

Restaino

et al. 2016

The Journal of Heart and Lung Transplantation

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Section: Resultsmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 98%

Dobutamine stress echocardiography is inadequate to detect early cardiac allograft vasculopathy

Clerkin

Farr

Restaino

et al. 2016

The Journal of Heart and Lung Transplantation

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“…There have been extensive recent comprehensive publications on imaging evaluation of CAV, which is beyond the scope of this present review . Table summarizes imaging modalities utilized for CAV . Invasive coronary angiography is recommended by the International Society of Heart and Lung Transplantation (ISHLT) as the diagnostic gold standard for CAV and for grading of disease severity (Table ) .…”

Section: Imaging Surveillancementioning

confidence: 99%

Cardiac allograft vasculopathy: Insights on pathogenesis and therapy

Lee

Nair

Chih

2020

Clinical Transplantation

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Cardiac allograft vasculopathy (CAV) is a unique accelerated form of coronary vascular disease affecting heart transplant recipients. This complication is a significant contributor to medium‐ to long‐term post‐transplant morbidity and mortality. There is a high prevalence of CAV with approximately one in three patients developing CAV by 5 years post‐transplant. Morphologically, CAV is characterized by concentric coronary intimal hyperplasia in both the epicardial arteries and intramural microvasculature. Although several immune and non‐immune factors have been identified, their precise pathogenic mechanisms, interactions, and relative importance in the development of CAV are not well defined. The advent of improved imaging surveillance modalities has resulted in earlier detection during the disease process. However, overall management of CAV remains challenging due to paucity of treatment. This review aims to discuss key concepts on the pathogenesis of CAV and current management strategies, focusing on the use of mammalian target of rapamycin inhibitors.

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“…44 Recently, two independent studies including over 500 patients questioned the adequacy of DSE to detect angiographic CAV, finding that in clinical practice the sensitivity of DSE was only 6.5% in ISHLT CAV1, 27% in ISHLT CAV2, and 24% in ISHLT CAV3. 45, 46 …”

Section: Non-invasive Testingmentioning

confidence: 99%

New developments for the detection and treatment of cardiac vasculopathy

Clerkin

Ali²,

Mancini³

2017

Current Opinion in Cardiology

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Purpose of Review Cardiac allograft vasculopathy (CAV) is a major limitation to long term survival after heart transplantation. Innovative new techniques to diagnose CAV have been applied to detect disease. This review will examine the current diagnostic and treatment options available to clinicians for CAV. Recent Findings Diagnostic modalities addressing the pathophysiology underlying CAV (arterial wall thickening and decreased coronary blood flow) improve diagnostic sensitivity when compared to traditional (angiography and dobutamine stress echocardiography) techniques. Summary Limited options are available to prevent and treat CAV; however progress has been made in making an earlier and more accurate diagnosis. Future research is needed to identify the optimal time to modify immunosuppression and investigate novel treatments for CAV.

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Dobutamine stress echocardiography during follow-up surveillance in heart transplant patients: Diagnostic accuracy and predictors of outcomes

Cited by 56 publications

References 35 publications

Dobutamine stress echocardiography is inadequate to detect early cardiac allograft vasculopathy

Dobutamine stress echocardiography is inadequate to detect early cardiac allograft vasculopathy

Cardiac allograft vasculopathy: Insights on pathogenesis and therapy

New developments for the detection and treatment of cardiac vasculopathy

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