Document Detail

Dobutamine stress echocardiography in heart transplant recipients' evaluation: the role of reinnervation.
MedLine Citation:
PMID:  20304187     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Orthotopic heart transplantation renders the recipient denervated. This remodeling of the intrinsic cardiac nervous system should be taken in account during functional evaluation for allograft coronary artery disease. Dobutamine stress echocardiography (DSE) has been used to detect patients at greater risk. The aim of this study was to determine whether patients with various autonomic response levels, and supposed reinnervation patterns, show the same response to DSE. METHODS: We studied 20 patients who had survived more than 5 years after orthotopic heart transplantation. All patients underwent a Holter evaluation. We considered patients with low variability to be those with less than a 40-bpm variation from the lowest to highest heart rate, so-called "noninnenervated" (group NI). Patients who had 40-bpm or more variation were considered to show high variability and called "reinnervated" (group RI). After that, all patients performed an ergometric test and DSE. RESULTS: Groups were defined as NI (n = 9) and RI (n = 11). Ergometric tests confirmed this response with NI patients showing less variability when compared to RI patients (P = .0401). During DSE, patients showed similar median heart rate responses according to the dobutamine dose. Spearmen correlation showed r = 1.0 (P = .016). CONCLUSIONS: DES was effective to reach higher heart rates, probably related to catecholamine infusion. These findings may justify a better response when evaluating cardiac allograft vasculopathy in heart transplant patients.
F Bacal; A Abuhab; S Mangini; A I Fioreli; R H B Santos; N G Stolf; E A Bocchi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  42     ISSN:  1873-2623     ISO Abbreviation:  Transplant. Proc.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-22     Completed Date:  2010-08-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  539-41     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Elsevier Inc. All rights reserved.
Cardiology Department, Heart Failure Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
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MeSH Terms
Adrenergic beta-Agonists / diagnostic use*
Cardiotonic Agents / adverse effects,  diagnostic use
Coronary Angiography
Dobutamine / diagnostic use*
Echocardiography / methods*
Follow-Up Studies
Heart Rate / physiology*
Heart Transplantation / adverse effects,  physiology*,  ultrasonography*
Heart Ventricles / physiopathology,  ultrasonography
Middle Aged
Postoperative Complications / ultrasonography
Time Factors
Reg. No./Substance:
0/Adrenergic beta-Agonists; 0/Cardiotonic Agents; 34368-04-2/Dobutamine

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