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(Circulation. 1999;100:509-515.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Diagnostic and Prognostic Value of Serial Dobutamine Stress Echocardiography for Noninvasive Assessment of Cardiac Allograft Vasculopathy

A Comparison With Coronary Angiography and Intravascular Ultrasound

Christoph H. Spes, MD; Volker Klauss, MD; Harald Mudra, MD; Susanne D. Schnaack, MD; Andres R. Tammen, MD; Johannes Rieber, MD; Uwe Siebert, MPH; Karl-Heinz Henneke, MD; Peter Überfuhr, MD; Bruno Reichart, MD; Karl Theisen, MD; Christiane E. Angermann, MD

From the Departments of Cardiology (Medizinische Klinikum Innenstadt) (C.H.S., V.K., H.M., S.D.S., A.R.T., J.R., K.-H.H., K.T., C.E.A.) and Cardiac Surgery (Klinikum Großhadern) (P.U., B.R.), and the Institute of Medical Informatics, Biometry, and Epidemiology (U.S.), University of Munich, Germany.

Correspondence to Christoph H. Spes, MD, Medizinische Klinikum Innenstadt, University of Munich, Ziemssenstraße 1, D-80336 München, Germany.

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.

Key Words: transplantation • coronary disease • stress • echocardiography

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