Quantitative Dobutamine Stress Echocardiography for the Early Detection of Cardiac Allograft Vasculopathy in Heart Transplant Recipients

Elif Eroglu ¹, Jan D'hooge ^1*, George R Sutherland ¹, Anna Marciniak ¹, Daisy Thijs ¹, Walter Droogne ¹, Lieven Herbots ¹, Johan Van Cleemput ¹, Piet Claus ¹, Bart Bijnens ¹, Johan Vanhaecke ¹ and Frank Rademakers ¹

¹ Catholic University of Leuven, Belgium

^* To whom correspondence should be addressed. E-mail: jan.dhooge{at}uz.kuleuven.be.

Accepted 7 August 2007

Abstract

Introduction A non-invasive method to detect the presence of cardiac allograft vasculopathy (CAV) remains an important goal in clinical cardiology. The aim of the present study was therefore to assess the value of quantitative dobutamine stress echocardiography (DSE) for the early detection of CAV.

Methods 42 heart transplant recipients underwent DSE with acquisition of both conventional 2D and color tissue Doppler data. All studies were analyzed both conventionally and quantitatively using regional deformation parameters, i.e. peak systolic longitudinal strain (åpeak sys), strain rate (SR peak sys) and post-systolic strain index (PSI). Myocardial segments were classified as normal, mildly abnormal or severely abnormal based on correlative angiographic findings.

Results At baseline, åpeak sys was significantly lower in severely abnormal segments compared to the normal ones. However, at peak stress, åpeak sys was able to separate three groups of segments. ROC analysis showed a SR peak sys response of < 0.5 s-1 to identify patients with CAV with a sensitivity of 88%, specificity of 85% and a negative predictive value of 92%.

Conclusion Regional myocardial function is impaired in heart transplant recipients with CAV even when the disease is considered to be non-significant on conventional angiography. Systolic deformation parameters tended to detect the existence of CAV more accurately than conventional visual DSE assessment. Strain rate imaging during stress can therefore safely be used as a non-invasive screening test for detecting CAV in heart transplant recipients.

Keywords: Allograft vasculopathy, Echocardiography, Heart transplantation, Strain Rate Imaging, Stress testing

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