Dobutamine stress echocardiography for noninvasive diagnosis of cardiac allograft vasculopathy: A comparison with angiography and intravascular ultrasound

Spes, Christoph; Mudra, Harald; Schnaack, Susanne D.; Klauß, Volker; Reichle, Florian M.; Überführ, P.; Theisen, K.; Angermann, Christiane E.

doi:10.1016/s0002-9149(96)90391-4

Cited by 81 publications

(31 citation statements)

References 17 publications

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“…61,62 When intimal thickening by intravascular ultrasound is taken as the "gold standard," dobutamine stress echocardiography shows specificities of up to 88%. 63,64 Moreover, a predictive value of dobutamine stress echocardiography for development of future CAV and outcome has been described. 64,65 Single-Photon Emission CT Annual myocardial single-photon emission CT (SPECT) has a high negative predictive value and appears to be well suited to screening for significant CAV.…”

Section: Dobutamine Stress Echocardiographymentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

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Abstract-Cardiac allograft vasculopathy (CAV) continues to limit the long-term success of cardiac transplantation.Recent insights have underscored the fact that innate and adaptive immune responses are involved in the pathogenesis of CAV. Vascular lesions are the result of cumulative endothelial injuries induced both by alloimmune responses and by nonspecific insults (including ischemia-reperfusion injury, viral infections, and metabolic disorders) in the context of impaired repair mechanisms. Intravascular ultrasound is the most sensitive method for detection of CAV, and progressive intimal thickening in the first posttransplant year identifies patients at high risk for future cardiovascular events. Encouraging results with regard to the detection of CAV by noninvasive methods should be an incentive to apply routine noninvasive imaging during mid-to long-term follow-up. Improved immunosuppressive drugs, including mycophenolate mofetil and proliferation signal inhibitors, as well as statins (in part via immunomodulation), have beneficial effects on CAV progression, although there is still a need to confirm the impact of vasodilators in improving outcome after heart transplantation. Coronary revascularization for CAV is only palliative, with no long-term survival benefit. Three main strategies for CAV prevention are currently under investigation: inhibition of growth factors and cytokines, cell therapy, and tolerance induction. However, because individual responses to an allograft change over time, assays to monitor the recipient's immune response and individualized methods for therapeutic immune modulation are clearly needed. (Circulation. 2008;117:2131-2141.)

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Section: Dobutamine Stress Echocardiographymentioning

confidence: 99%

Cardiac Allograft Vasculopathy

2008

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“…Using intravascular ultrasound (IVUS) as the gold standard for diagnosis, dobutamine echocardiography can detect patients with cardiac allograft vasculopathy with a sensitivity of 79%, specificity of 88%, positive predictive value of 88%, and negative predictive value of 71% [11]. Although by no means a replacement for invasive testing, dobutamine stress echocardiography has a diagnostic role in patients unable to undergo invasive testing or to assess if the angiographically detected coronary vasculopathy produces clinically significant allograft dysfunction and ischemia.…”

Section: Opinion Statementmentioning

confidence: 99%

Transplant coronary vasculopathy

Pamboukian

Costanzo

2001

Curr Treat Options Cardio Med

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Because the transplanted heart is denervated, classic angina as a symptom of allograft coronary vasculopathy rarely is perceived. Any cardiac transplant patients who presents with decreased exercise capacity, shortness of breath, or syncope should be assessed thoroughly. Unfortunately, the initial presenting symptom of transplant vasculopathy may be acute myocardial infarction, heart failure, or even sudden death. Patients should be evaluated on an annual basis for the presence of transplant coronary vasculopathy in addition to when clinical suspicion warrants. Coronary angiography has been the main modality of invasive assessment, although it is insensitive. Recently, intracoronary ultrasound has been used in conjunction with angiography to detect the first evidence of transplant vasculopathy, manifested as thickening of the intimal layer of the vessel wall due to smooth muscle cell proliferation, which ultimately leads to luminal narrowing. Patients with evidence of vasculopathy should undergo functional evaluation with dobutamine echocardiography to document ischemic burden. Preventive measures include traditional coronary risk factor modification. Patients are started on statins early in the post-transplantation period and hypertension is treated aggressively using calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors. Because of their deleterious metabolic effects, steroids may be withdrawn under close surveillance for rejection. After transplant vasculopathy has developed, it is difficult to treat and options are limited. Patients with discrete luminal obstructions may undergo angioplasty, stenting, or coronary artery bypass. However, these procedures are palliative, and the only definitive therapy is retransplantation.

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“…The blunted heart rate response to exercise because of cardiac denervation limits the sensitivity (range 15% to 33%) of exercise testing to detect CAV (29 -31). In contrast, the use of pharmacologic stress testing (dipyridamole and dobutamine) to detect CAV has been shown to be more sensitive (ϳ85%; range 50% to 100%) (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). The variable specificity (range 41% to 95%) of dobutamine stress echocardiography (DSE) is likely a reflection of the differences in defining the presence and severity of CAV by coronary angiography.…”

Section: Cavmentioning

confidence: 99%

The Role of Multimodality Cardiac Imaging in the Transplanted Heart

Estep¹,

Shah²,

Nagueh³

et al. 2009

JACC: Cardiovascular Imaging

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Heart transplantation (HT) is an established life-saving treatment option for patients with end-stage heart failure. Despite many advances in the field, the development of acute cellular rejection (ACR) and cardiac allograft vasculopathy (CAV) represent significant causes of 1- and 5-year morbidity and mortality, respectively. The search for noninvasive techniques to assess cardiac allograft function and detect treatable ACR and CAV remains a priority objective for heart transplant professionals. In this review we will: 1) highlight the clinical significance of ACR and CAV in adult cardiac transplant recipients and 2) discuss how different noninvasive imaging modalities (echocardiography, cardiac computed tomography, myocardial perfusion imaging, and cardiac magnetic resonance) have been used in the evaluation of these clinical challenges after HT.

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Dobutamine stress echocardiography for noninvasive diagnosis of cardiac allograft vasculopathy: A comparison with angiography and intravascular ultrasound

Cited by 81 publications

References 17 publications

Cardiac Allograft Vasculopathy

Cardiac Allograft Vasculopathy

Transplant coronary vasculopathy

The Role of Multimodality Cardiac Imaging in the Transplanted Heart

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