Fang J C, Rocco T, Jarcho J, Ganz P, Mudge G H
Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass 02115, USA.
Am Heart J. 1998 Jun;135(6 Pt 1):980-7. doi: 10.1016/s0002-8703(98)70062-6.
Transplant-associated arteriosclerosis is the major limitation to long-term survival in the cardiac transplant recipient, and annual surveillance angiography is used in many centers to monitor its progression. Noninvasive methods would be preferable because angiography is invasive, costly, and insensitive; however, the reliability of such methods has been questioned.
All publications relating to the assessment of the cardiac allograft by noninvasive testing were identified through MEDLINE and a review of references from the published literature on transplant-associated arteriosclerosis.
Resting and stress ECG, radionuclide scintigraphy, echocardiography, and positron emission tomography have all been used in cardiac transplant recipients with variable results. Most techniques are insensitive, but this limitation may be improved with pharmacologic stress imaging like dobutamine echocardiography. Although insensitive, some methods have good specificity (i.e., radionuclide scintigraphy). The noninvasive measurement of absolute coronary blood flow is promising as a specific and sensitive technique but is limited by availability and cost.
In general, noninvasive techniques to assess transplant-associated coronary arteriosclerosis are limited by variable sensitivity and specificity. However, certain methods, such as dobutamine echocardiography and radionuclide scintigraphy, can provide important adjunctive physiologic information to angiography. Such techniques can therefore help to guide the care and treatment of the cardiac transplant recipient with allograft coronary arteriosclerosis.
移植相关动脉硬化是心脏移植受者长期生存的主要限制因素，许多中心采用年度监测血管造影术来监测其进展情况。由于血管造影术具有侵入性、成本高且不敏感，因此非侵入性方法更为可取；然而，此类方法的可靠性受到质疑。
通过MEDLINE以及对已发表的关于移植相关动脉硬化文献的参考文献进行检索，找出所有与通过非侵入性检测评估心脏移植相关的出版物。
静息和负荷心电图、放射性核素闪烁扫描、超声心动图以及正电子发射断层扫描均已应用于心脏移植受者，结果各异。大多数技术不敏感，但像多巴酚丁胺超声心动图这样的药物负荷成像可能会改善这一局限性。尽管不敏感，但一些方法具有良好的特异性（如放射性核素闪烁扫描）。绝对冠状动脉血流的非侵入性测量作为一种特异且敏感的技术很有前景，但受到可用性和成本的限制。
一般而言，评估移植相关冠状动脉硬化的非侵入性技术受敏感性和特异性变化的限制。然而，某些方法，如多巴酚丁胺超声心动图和放射性核素闪烁扫描，可为血管造影术提供重要的辅助生理信息。因此，此类技术有助于指导心脏移植受者合并移植冠状动脉硬化的护理和治疗。
