Abstract 2584: Left Ventricular Systolic Wall Motion Velocity Surveillance for Early Detection of Patients with Transplant Coronary Artery Disease
Background: The prevalence of angiographically detectable transplant coronary artery disease (TxCAD) increases continuously after heart transplantation. Coronary angiographic (CA) screenings often fail to detect TxCAD appearance or progression before first clinical events. Previously we found that systolic wall motion peak velocities (Sm) at left ventricular (LV) basal regions are lower in patients with angiographic TxCAD, before regional wall motion alterations or LVEF changes emerge. Sm measurements with pulsed-wave tissue Doppler (PW-TD) also showed high reproducibility. Now we assessed prospectively the clinical value of Sm for early detection of patients with anigiographic TxCAD.
Methods: In 51 transplanted patients without detectable TxCAD at first follow-up CA, we assessed the time course of radial and longitudinal Sm in relation to angiographic findings over a period of 5 years. Serial Sm measurements were performed by PW-TDI at the basal LV posterior wall (parasternal short and apical long axes views for radial and longitudinal Sm, respectively) prior to each follow-up CA. Myocardial biopsies were taken before CA. Sm was evaluated only after exclusion of acute rejection (AR).
Results: CA monitoring revealed in 38 patients (74.5%) the development of angiographic TxCAD lesions. Of these, 34 (89.5%) showed diffuse type B1 or B2 lesions without focal stenoses, the other 4 (10.5%) showed also focal stenoses of the main epicardial coronary vessels. Although LVEF changes were not significant in these 38 patients, the mean radial Sm value at the time of TxCAD diagnosis was significantly lower than initially (9.6 ±2.6 vs. 12.5 ±4.6 cm/s; p <0.001). In the 13 patients without angiographic TxCAD there were no radial Sm changes (11.9 ±3.1 vs. 11.8 ±2.3 cm/s). In patients without AR, radial Sm reductions of >10% showed positive predictive values for angiographic TxCAD of 95.0%. Longitudinal Sm also showed significant reduction with TxCAD (p <0.01), but less predictive value for TxCAD diagnosis.
Conclusions: Because Sm reduction is highly predictive for angiographic TxCAD, PW-TDI can be used for the timing angiographies. After exclusion of acute rejection, all patients with Sm drop of > 10% in comparison to previous measurements should be considered for CA.