Dobutamine stress echocardiography during follow-up surveillance in heart transplant patients: Diagnostic accuracy and predictors of outcomes
Dobutamine stress echocardiography during follow-up surveillance in heart transplant patients: Diagnostic accuracy and predictors of outcomes
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DOI：
10.1016/j.healun.2014.11.019
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发表时间：
2015-05-01
影响因子：
8.9
通讯作者：
Desai, Milind Y.
中科院分区：
文献类型：
--
作者：
Chirakarnjanakorn, Srisakul;Starling, Randall C.;Desai, Milind Y.
背景技术背景：心脏移植物血管病变（CAV）是原位心脏移植（OHT）后3年以上移植物衰竭和死亡的主要原因，通常使用多巴酚丁胺负荷超声心动图（DSE）进行评估。我们试图研究：（a）DSE阳性结果的发生率和诊断准确性;以及。(b)方法：我们研究了497例连续的OHT患者（63 +/- 10岁，78%为男性），他们在1998年至2013年期间在我们中心接受了DSE作为常规监测的一部分。对随访期间进行的每次DSE和冠状动脉造影进行了审查。根据国际心肺移植学会2010年的建议，对CAV进行了重新分级。复合事件（死亡，冠状动脉血运重建，心肌梗死和再次移植）recorded.Results：有1,243 DSE研究中进行的中位数为8.7（6.2至11.9）年移植后。只有22项研究（1.8%）为阳性，978项（78.7%）为阴性，243项（19.5%）为非诊断性（次最大心率反应）缺血。在497例患者中，只有20例（4%）至少有一项阳性DSE研究。有310例诊断性DSE在1年内进行了冠状动脉造影。DSE检测CAV的敏感性、特异性、阳性预测值和阴性预测值分别为7%、98%、82%和41%，检测CAV 2级和3级的敏感性、特异性、阳性预测值和阴性预测值分别为28%、98%、71%和89%。DSE期间无死亡。在DSE后5.6 +/- 3.6年，有201例（40%）事件。CAV的程度（而不是DSE为基础的缺血，p = 0.3）独立预测预后（p < 0.001）。结论：在接受DSE监测的OHT患者中，阳性结果的发生率非常低。DSE对早期CAV的检测灵敏度不够。CAV的程度而不是基于DSE的缺血独立预测结果。(C)2015年国际心肺移植学会。All rights reserved.
BACKGROUND: Cardiac allograft vasculopathy (CAV), a major cause of graft failure and mortality at >3 years after orthotopic heart transplantation (OHT), is commonly evaluated using dobutamine stress echocardiography (DSE). We sought to study: (a) the incidence of positive results and diagnostic accuracy of DSE; and.(b) the predictors of adverse outcomes in OHT patients.METHODS: We studied 497 consecutive patients (63 +/- 10 years, 78% men) with OHT who had undergone DSE as part of routine surveillance at our center between 1998 and 2013. Every DSE and coronary angiogram performed during follow-up was reviewed. CAV was regraded according to the 2010 recommendations of the International Society for Heart and Lung Transplantation. Composite events (death, coronary revascularization, myocardial infarction and retransplantation) were recorded.RESULTS: There were 1,243 DSE studies performed during a median of 8.7 (6.2 to 11.9) years after transplantation. Only 22 studies (1.8%) were positive, 978 (78.7%) were negative and 243 (19.5%) were non-diagnostic (sub-maximal heart rate response) for ischemia. Among 497-patients, only 20 (4%) had at least one positive DSE study. There were 310 diagnostic DSEs with coronary angiograms performed within 1 year of one another other. In this subgroup, the sensitivity, specificity, positive predictive value and negative predictive value of DSE were 7%, 98%, 82% and 41%, respectively, to detect any CAV, and 28%, 98%, 71% and 89% to detect CAV Grades 2 or 3, respectively. There were no deaths during DSE. At 5.6 +/- 3.6 years after DSE, there were 201 (40%) events. Degree of CAV (and not DSE-based ischemia, p = 0.3) independently predicted outcomes (p < 0.001).CONCLUSIONS: The incidence of a positive result is very low in OHT patients undergoing surveillance DSE. DSE is insufficiently sensitive for detection of early CAV. Degree of CAV and not DSE-based ischemia independently predicted outcomes. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.