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

Ciliberto, Gennaro; Ruffini, Livia; Mangiavacchi, Maurizio; Parolini, Marina; Sara, Roberto; Massa, D.; Maria, Renata De; Gronda, Edoardo; Vitali, Ettore; Parodi, Oberdan

doi:10.1053/euhj.2000.2422

Cited by 66 publications

(42 citation statements)

References 18 publications

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“…The role of stress ECG is limited, because of the diminished chronotropic response to physical exercise (4). In the setting of significant CAV, it has been suggested that a strategy, which reserves angiography for patients with echocardiographic resting wall motion abnormalities and/or stress perfusion defects may be safe and cost-effective, leading to 85% accuracy (11). Others reported a limited sensitivity (57%) for resting echocardiography (9); in keeping with this, we did not detect resting wall motion abnormalities in patients with significant CAV.…”

Section: Discussionsupporting

confidence: 67%

“…Others reported a limited sensitivity (57%) for resting echocardiography (9); in keeping with this, we did not detect resting wall motion abnormalities in patients with significant CAV. Anyhow, our CFR results in significant CAV indicate that CE-TTE, using the optimal ROC defined cut point of 2.7, is comparable to the combination of resting echocardiography and stress scintigraphy (11), with 83% accuracy.…”

Section: Discussionmentioning

confidence: 97%

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Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Tona

Caforio

Montisci

et al. 2006

American Journal of Transplantation

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Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrastenhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50 ± 12 years at HT), at 8 ± 4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of ≤2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3 ± 0.7 vs. 3.2 ± 0.5, p < 0.0001). The ≤2 cut point was 100% specific and 38% sensitive. The ≤2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard ≤2 cut point to 85% with the optimal cut point of ≤2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 97%

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Tona

Caforio

Montisci

et al. 2006

American Journal of Transplantation

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“…66,67 The surveillance intensity of coronary angiography might be designed reasonably and safely on the basis of noninvasive monitoring of dobutamine 201 Tl SPECT testing 67 or on the basis of the combination of resting echocardiography and quantitative stress 99m Tc sestamibi SPECT. 68 The latter strategy reserves coronary angiography for patients with resting wall-motion abnormalities or perfusion defects.…”

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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“…When using Dobutamine stress and 99m technetium tetrofosmin, abnormal perfusion is associated to a risk ratio of 3.5 in predicting cardiac death [78][79][80] . A reversible perfusion defect on stress SPECT is an independent predictor of mortality or graft loss [72,[81][82][83] and it seems that stress SPECT at one year post transplantation could be an earlier prognostic indicator [84] . In Pediatrics, the experience with SPECT is largely anecdotal.…”

Section: Single Photon Emission Computed Tomographymentioning

confidence: 99%

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

Dedieu

Greil

Wong

et al. 2014

WJT

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Coronary allograft vasculopathy remains one of the leading causes of death beyond the first year post transplant. As a result of denervation following transplantation, patients lack ischaemic symptoms and presentation is often late when the graft is already compromised. Current diagnostic tools are rather invasive, or in case of angiography, significantly lack sensitivity. Therefore a non-invasive tool that could allow early diagnosis would be invaluable.This paper review the disease form its different diagnosis techniques,including new and less invasive diagnostic tools to its pharmacological management and possible treatments. DEFINITION AND PHYSIOPATHOLOGYIn children, coronary allograft vasculopathy (CAV) remains the main limiting survival factor after heart transplantation and the major cause of mortality after the first year post transplant leading ultimately to graft loss [1,2] . One elegant etiological description of CAV is that of "immunologic mechanisms operating in a milieu of nonimmunologic risk factors" [3] . The process is believed to start off as a response to endothelial injury in the graft, originated by a complex interaction of multiple donor and recipient factors. The resulting endothelial dysfunction, leads to altered endothelial permeability and subsequent intimal hyperplasia as a consequence of the vascular remodeling originated by the inflammatory response. The immunologic events constitute the original trigger and noninflammatory events such as cytomegalovirus infection, ischemic time (reperfusion injury), increased donor age and classical cardiovascular risk factors (i.e., diabetes, dyslipidemias, smoking and hypertension), perpetuate the inflammatory response and increase the endothelial injury [4] . Typical lesions (Figures 1 and 2) consist of diffuse intimal proliferation leading to the development of luminal stenosis and small vessels occlusion which then limits blood supply to the graft causing chronic vascular injury and ultimately myocardial ischemia [5] . The lesions develop earlier and quicker than atherosclerotic lesions. REVIEW 276December 24, 2014|Volume 4|Issue 4|

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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

Cited by 66 publications

References 18 publications

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Cardiac Allograft Vasculopathy

Diagnosis and management of coronary allograft vasculopathy in children and adolescents

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