Diagnostic and Prognostic Value of Serial Dobutamine Stress Echocardiography for Noninvasive Assessment of Cardiac Allograft Vasculopathy
| Autor: | Uwe Siebert, Karl Theisen, Christiane E. Angermann, Peter Überfuhr, Bruno Reichart, Susanne D. Schnaack, Johannes Rieber, Andres R. Tammen, Christoph H. Spes, K.-H. Henneke, Volker Klauss, Harald Mudra |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male Risk medicine.medical_specialty medicine.medical_treatment Coronary Disease Coronary Angiography Predictive Value of Tests Dobutamine Physiology (medical) Intravascular ultrasound medicine Humans Transplantation Homologous Prospective Studies Prospective cohort study Ultrasonography Interventional Heart transplantation medicine.diagnostic_test business.industry Vascular disease Confounding Factors Epidemiologic Adrenergic beta-Agonists Middle Aged Prognosis medicine.disease Transplantation Echocardiography Predictive value of tests Angiography Disease Progression cardiovascular system Heart Transplantation Female Radiology Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Circulation. 100:509-515 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Background —Routine methods for surveillance of cardiac allograft vasculopathy (CAV) are coronary angiography and intravascular ultrasound (IVUS). This study analyzed the diagnostic and prognostic value of dobutamine stress echocardiography (DSE) for noninvasive assessment of CAV. Methods and Results —In 109 heart transplant recipients, 333 DSEs were compared with 285 coronary angiograms and 199 IVUS analyses. Studies were repeated after 1, 2, 3, 4, and ≥5 years in 88, 74, 37, 18, and 7 patients, respectively. Resting 2D echocardiography detected CAV defined by IVUS and angiography with a sensitivity of 57% (specificity 88%). DSE increased the sensitivity to 72% ( P =0.002). M-mode analysis increased the sensitivity of 2D rest and stress analysis ( P =0.001, 0.004). Cardiac events occurred after 1.9% of normal stress tests by 2D analysis (combined 2D and M-mode: 0%), compared with 6.3% (3.8%) of normal resting studies. Worsening of serial DSE indicated an increased risk of events compared with no deterioration (relative risk 7.26, P =0.0014). Serial deterioration detected by stress only was associated with a higher risk of events than changes evident from resting studies (relative risk 3.06, P =0.0374). Conclusions —DSE identifies patients at risk for events and facilitates monitoring of CAV. A normal DSE predicts an uneventful clinical course and justifies postponement of invasive studies. The prognostic value of DSE is comparable to that of IVUS and angiography. |
| Databáze: | OpenAIRE |
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