Cardiac allograft vasculopathy other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Non-invasive testing by stress electrocardiography is of limited use in the diagnosis of cardiac allograft vasculopathy (CAV) due to high frequency of baseline electrocardiographic abnormalities and the reduced exercise tolerance in heart transplant recipients. Therefore adjunctive imaging in the form of stress echocardiogram and radionuclide imaging to improve sensitivity and specificity has been used for this purpose.

Other Imaging Findings

Dobutamine Stress Echocardiogram

Akosah et al first reported the use of dobutamine stress echocardiogram (DSE) in the diagnosis of CAV.[1] The study demonstrated the sensitivity, specificity, negative predictive value and positive predictive value of DSE to be 95%, 55%, 69% and 92% respectively. Subsequently several studies compared the efficacy of DSE in combination with coronary angiography and with or without intravascular ultrasound for detecting the presence and severity of CAV.[2][3][4][5][6] Spes et al, in a study to evaluate the value of DSE for non-invasive diagnosis of CAV compared with coronary angiography and IVUS, demonstrated that regional myocardial dysfunction as assessed by DSE correlated well with IVUS-derived evidence of moderate to severe intimal hyperplasia. The study concluded that DSE could be used as a feasible alternative noninvasive diagnostic method to diagnose CAV and may indeed reduce the need for frequent invasive screening by coronary angiography.[5] In a similar study by the same group to determine the prognostic value of DSE in CAV compared with coronary angiography and IVUS it was found that the prognostic value of DSE was comparable to that of angiography and IVUS.[4] Across several studies, the sensitivity, specificity, positive predictive value and negative predictive value of DSE for the diagnosis of CAV in comparison to angiography has been reported to be ranging from 65% to 95%, 55% to 95%, 69% to 92%, and 71% to 92%, respectively.[7] However, with the addition of IVUS to coronary angiography and DSE the sensitivity and negative predictive value of DSE were reported to be low compared with IVUS.[7]

References

  1. Akosah KO, Mohanty PK, Funai JT, Jesse RL, Minisi AJ, Crandall CW; et al. (1994). "Noninvasive detection of transplant coronary artery disease by dobutamine stress echocardiography". J Heart Lung Transplant. 13 (6): 1024–38. PMID 7865509.
  2. Derumeaux G, Redonnet M, Soyer R, Cribier A, Letac B (1998). "Assessment of the progression of cardiac allograft vasculopathy by dobutamine stress echocardiography". J Heart Lung Transplant. 17 (3): 259–67. PMID 9563602.
  3. Akosah KO, McDaniel S, Hanrahan JS, Mohanty PK (1998). "Dobutamine stress echocardiography early after heart transplantation predicts development of allograft coronary artery disease and outcome". J Am Coll Cardiol. 31 (7): 1607–14. PMID 9626841.
  4. 4.0 4.1 Spes CH, Klauss V, Mudra H, Schnaack SD, Tammen AR, Rieber J; et al. (1999). "Diagnostic and prognostic value of serial dobutamine stress echocardiography for noninvasive assessment of cardiac allograft vasculopathy: a comparison with coronary angiography and intravascular ultrasound". Circulation. 100 (5): 509–15. PMID 10430765.
  5. 5.0 5.1 Spes CH, Mudra H, Schnaack SD, Klauss V, Reichle FM, Uberfuhr P; et al. (1996). "Dobutamine stress echocardiography for noninvasive diagnosis of cardiac allograft vasculopathy: a comparison with angiography and intravascular ultrasound". Am J Cardiol. 78 (2): 168–74. PMID 8712138.
  6. Derumeaux G, Redonnet M, Mouton-Schleifer D, Bessou JP, Cribier A, Saoudi N; et al. (1995). "Dobutamine stress echocardiography in orthotopic heart transplant recipients. VACOMED Research Group". J Am Coll Cardiol. 25 (7): 1665–72. PMID 7759721.
  7. 7.0 7.1 Pollack A, Nazif T, Mancini D, Weisz G (2013). "Detection and imaging of cardiac allograft vasculopathy". JACC Cardiovasc Imaging. 6 (5): 613–23. doi:10.1016/j.jcmg.2013.03.001. PMID 23680373.

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