Abstract 16891: Prevalence of Positive Dobutamine Stress Echocardiography During Follow Up Surveillance in Heart Transplant Patients
Background: Cardiac allograft vasculopathy (CAV), an important cause of graft failure and mortality after first year of orthotopic heart transplant (OHT), is routinely evaluated using dobutamine stress echocardiography (DSE). We sought to study the incidence of positive DSE in OHT patients.
Methods: We studied 497 consecutive patients (age 63±10 years, 78% men) with OHT who underwent DSE as part of routine surveillance at our center between 1998 and 2013. Every DSE performed during follow-up was systematically reviewed.
Results: In 497 patients, prevalence of diabetes, hypertension, dyslipidemia and post-OHT revascularization were 38%, 84%, 38% and 11% respectively. In this group, there were 1243 DSE studies performed during 9.4±4.2 years following OHT. At rest, mean left ventricular ejection fraction and end-systolic dimension were 57±6% and 2.8±0.6 cm, respectively. There were 33% with ≥2+ tricuspid regurgitation, 3.6% with ≥2+ mitral regurgitation, and 2.8% right ventricular dysfunction with a mean right ventricular systolic pressure of 32±9 mmHg. At peak dobutamine infusion, % peak predicted heart rate was 87±9%. Heart rate was significantly higher at peak infusion (83±13 vs. 136±15 beats/minute, p<0.001). Systolic blood pressure was significantly increased (143±22 vs. 152±32 mmHg, p<0.001), whereas diastolic blood pressure was significantly decreased (81±12 vs.74±16 mmHg, p<0.001) at rest vs. peak. Two patients developed sustained ventricular tachycardia, 2 had hypotension and 1 had junctional bradycardia. All were asymptomatic and arrhythmias terminated spontaneously after stopping dobutamine infusion. There were no serious events or death during DSE. Only 22 studies (1.8%) were positive for ischemia, 978 (78.7%) were negative for ischemia and 243 (19.5%) were non-diagnostic (submaximal heart rate). Amongst 497 patients, only 20 (4%) had at least one positive DSE study. There was no association between duration from OHT and positive DSE (p = 0.71).
Conclusions: In OHT patients undergoing surveillance DSE, the incidence of a positive result is very low. This surveillance strategy in OHT patients should be re-visited in the current era of cost containment. Alternate noninvasive methods to evaluate for CAV need to be explored.
- © 2013 by American Heart Association, Inc.