Spes C H, Klauss V, Mudra H, Schnaack S D, Tammen A R, Rieber J, Siebert U, Henneke K H, Uberfuhr P, Reichart B, Theisen K, Angermann C E
Departments of Cardiology and Cardiac Surgery, the Institute of Medical Informatics, University of München, Germany.
Circulation. 1999 Aug 3;100(5):509-15. doi: 10.1161/01.cir.100.5.509.
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.
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).
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.
心脏移植血管病变（CAV）的常规监测方法是冠状动脉造影和血管内超声（IVUS）。本研究分析了多巴酚丁胺负荷超声心动图（DSE）对CAV进行无创评估的诊断和预后价值。
对109例心脏移植受者进行了333次DSE检查，并与285次冠状动脉造影和199次IVUS分析结果进行比较。分别在1、2、3、4和≥5年后对88、74、37、18和7例患者重复进行检查。静息二维超声心动图检测IVUS和血管造影定义的CAV，敏感性为57%（特异性88%）。DSE将敏感性提高到72%（P=0.002）。M型分析提高了二维静息和负荷分析的敏感性（P=0.001，0.004）。二维分析显示，1.9%的正常负荷试验后发生心脏事件（二维和M型联合分析：0%），而正常静息检查的发生率为6.3%（3.8%）。与无恶化相比，连续DSE恶化表明事件风险增加（相对风险7.26，P=0.0014）。仅负荷试验检测到的连续恶化与静息检查明显变化相比，事件风险更高（相对风险3.06，P=0.0374）。
DSE可识别有事件风险的患者，并有助于监测CAV。正常的DSE预示临床过程平稳，证明可推迟有创检查。DSE的预后价值与IVUS和血管造影相当。
