Mairesse G H, Marwick T H, Melin J A, Hanet C, Jacquet L, Dion R, Goenen M
Division of Cardiology, University of Louvain Medical School, Brussels, Belgium.
J Heart Lung Transplant. 1995 Mar-Apr;14(2):222-9.
Coronary artery disease has been reported to be a significant cause of long-term morbidity and mortality after heart transplantation. However, the diagnosis of coronary disease by means of noninvasive procedures has shown disappointing accuracy, and many centers currently recommend an annual surveillance coronary angiogram.
We prospectively studied the accuracy and feasibility of a symptom-limited upright bicycle exercise, combined with computerized electrocardiogram analysis, echocardiography, and perfusion scintigraphy in 37 consecutive heart transplant recipients at 2.8 +/- 1.4 years after transplantation for routine follow-up coronary angiography.
No patient had any hemodynamically significant (> 50% diameter) coronary stenosis, but luminal irregularities were detectable in four patients. The exercise electrocardiogram was interpretable in only 22 patients (59%), and two of the remaining patients (9%) had false-positive results. The feasibility of perfusion tomography (100%) and two-dimensional echocardiography (97%) were greater than for stress electrocardiogram (p < 0.001 and p < 0.01 respectively). False-positive results were obtained at stress echocardiography in one patient (3%), and at scintigraphy in six patients (16%, p = not significant). None of these methods detected coronary artery stenoses of less than 50% diameter.
Both exercise perfusion tomography and two-dimensional echocardiography are feasible and can be used with adequate specificity for the noninvasive diagnosis of coronary artery disease in heart transplant recipients. However further studies are needed to determine their respective sensitivity.
据报道，冠状动脉疾病是心脏移植后长期发病和死亡的重要原因。然而，通过非侵入性检查手段诊断冠状动脉疾病的准确性令人失望，目前许多中心建议每年进行一次冠状动脉造影监测。
我们前瞻性地研究了症状限制直立自行车运动结合计算机化心电图分析、超声心动图和灌注闪烁扫描在37例连续心脏移植受者中的准确性和可行性，这些受者在移植后2.8±1.4年接受常规冠状动脉造影随访。
没有患者出现任何血流动力学上显著（直径>50%）的冠状动脉狭窄，但在4例患者中可检测到管腔不规则。运动心电图仅在22例患者（59%）中可解读，其余患者中有2例（9%）出现假阳性结果。灌注断层扫描（100%）和二维超声心动图（97%）的可行性高于运动心电图（分别为p<0.001和p<0.01）。1例患者（3%）在负荷超声心动图检查时出现假阳性结果，6例患者（16%，p无显著性差异）在闪烁扫描时出现假阳性结果。这些方法均未检测到直径小于50%的冠状动脉狭窄。
运动灌注断层扫描和二维超声心动图对于心脏移植受者冠状动脉疾病的非侵入性诊断都是可行的，且具有足够的特异性。然而，需要进一步研究以确定它们各自的敏感性。
