Document Detail


Exercise echocardiography in heart transplant recipients: a comparison with angiography and intracoronary ultrasonography.
MedLine Citation:
PMID:  7947876     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Transplant coronary artery disease is the leading cause of allograft failure in heart transplant recipients surviving beyond 1 year. Coronary angiography still remains the major technique for surveillance of these patients, with recent use of intracoronary ultrasonography to detect the early stages of intimal thickening. We evaluated exercise echocardiography to screen for the presence or absence of angiographic evidence of transplant coronary artery disease in any vessel, defined as follows: absent; stenosis 39% or less = mild; stenosis 40% to 69% = moderate; or stenosis > or = 70%, or more = severe. Fifty-one consecutive heart transplant recipients undergoing routine annual evaluation were included in the study. Of thirty-seven patients with no coronary artery disease, thirty-two had a normal and five had an abnormal exercise echocardiogram. Fourteen patients (27%) had transplant coronary artery disease by angiographic criteria; six had mild, six had moderate, and two had severe stenosis. One patient with mild and the two patients with severe transplant coronary artery disease had abnormal exercise echocardiograms. None of the patients with moderate disease had an abnormal exercise echocardiogram (false negative). Of forty-three patients with no or mild stenosis, 19 patients had moderate to severe intimal proliferation as seen with intracoronary ultrasonography. Of eight patients with moderate or severe stenosis, four were tested with intracoronary ultrasonography and all had moderate to severe intimal proliferation. Six patients had a "false positive" exercise echocardiogram, and of four who were tested with intracoronary ultrasonography, two had mild and two had moderate to severe intimal thickening. In summary, exercise echocardiography correctly excluded the presence of transplant coronary artery disease in 86% of patients but was associated with a high false negative rate for detection of moderate coronary stenosis. A false positive exercise echocardiogram was associated with intimal proliferation by intracoronary ultrasonography in several patients and suggests that coronary angiography may underestimate significant coronary artery disease.
Authors:
C A Collings; F J Pinto; H A Valantine; S Popylisen; J V Puryear; I Schnittger
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  13     ISSN:  1053-2498     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:    1994 Jul-Aug
Date Detail:
Created Date:  1994-12-07     Completed Date:  1994-12-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  604-13     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Medicine, Stanford University Medical Center, CA 94305.
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MeSH Terms
Descriptor/Qualifier:
Coronary Angiography
Coronary Disease / etiology,  radiography,  ultrasonography*
Coronary Vessels / ultrasonography
Echocardiography*
Exercise Test
False Negative Reactions
False Positive Reactions
Female
Heart Transplantation / adverse effects,  radiography,  ultrasonography*
Humans
Male
Middle Aged
Ultrasonography, Interventional*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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