Insensitivity of noninvasive tests to detect coronary artery vasculopathy after heart transplant

Smart, Frank W.; Ballantyne, Christie M.; Cocanougher, B.; Farmer, John A.; Sekela, Michael E.; Noon, George P.; Young, James B.

doi:10.1016/0002-9149(91)90553-w

Cited by 188 publications

(62 citation statements)

References 16 publications

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“…This method was considered the gold standard for definition of the presence or absence of allograft vasculopathy. The test was considered positive for allograft vasculopathy when luminal obstruction was >50% [15][16][17] , and we used the designations: disease YES or NO. Lesions < 50% were considered as parietal irregularities and were not evaluated.…”

Section: Methodsmentioning

confidence: 99%

Analysis of the risk factors for allograft vasculopathy in asymptomatic patients after cardiac transplantation

Bacal¹,

Veiga²,

Fiorelli³

et al. 2000

Arq. Bras. Cardiol.

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Section: Methodsmentioning

confidence: 99%

Analysis of the risk factors for allograft vasculopathy in asymptomatic patients after cardiac transplantation

Bacal¹,

Veiga²,

Fiorelli³

et al. 2000

Arq. Bras. Cardiol.

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“…Sensitivity and positive prediction values were respectively 21% and 21% (Smart et al 76 ) and 0% and 0% (Ehrman et al 77 ). The detection and evaluation of the seriousness of coronary artery disease by myocardial scintilography has been considered class IIB following cardiac transplantation due to reduced sensitivity and specificity 78 .…”

Section: Work Rate Adaptation To Exercise Following Cardiac Transplanmentioning

confidence: 99%

Adaptation to exercise following cardiac transplantation

Af¹,

Ja²

2000

Arq. Bras. Cardiol.

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Cardiac transplantation has been the treatment of choice for patients with terminal cardiac insufficiency, increasing survival time by more than 80% in the first year 1 and by more than 50% over ten years 2 . Following cardiac transplantation, the quality of life improves considerably, and many transplanted patients return to work becoming reintegrated into the community 3 . During regular activity, transplanted subjects have shown physical conditioning similar to that of healthy individuals 4-7 . Starling's axiom, "today's physiology will be tomorrow's medicine" 8 , emphasizes the need for knowledge about post-transplantation cardiovascular adaptations, to serve as the basis for clinical treatment and rehabilitation. The present article has the aim of discussing the state-of -the-art of this subject.Aerobic capacity -Aerobic capacity is the total amount of O 2 capable of being metabolized by an organism. Aerobic potency is the amount of 0 2 consumed per unit of time (VO 2 ). Maximal O 2 consumption (VO 2 max.) or maximal aerobic potency is the maximum VO 2 obtained in an endurance (of progressive loads) test, in which VO 2 reaches a maximal value without additional increase due to an additional work load. In tests in which the patient does not reach maximum oxygen consumption, as frequently occurs in cardiopathy patients and transplanted subjects, peak VO 2 is defined as the highest value of VO 2 obtained. Following cardiac transplantation, patients progress with a reduction of peak VO 2 9-15 of 30-50% [16][17][18][19][20][21][22] . In our study 6,7 , deficits were 32.4% and 25.7% at peak exercise and at the anaerobic threshold, respectively. Marzo et al 18 found a 35% reduction in the absolute values of the anaerobic threshold. Degré et al 23 reported an early and intense accumulation of lactate during exercise, attributed to increased production in active tissues and reduced clearance secondary to decreased blood flow in the liver and other inactive tissues. In our study 7 , VO 2 in light to moderate submaximal exercise (40 watt load) below the anaerobic threshold was 12.34 and 12.38ml/kg/ min, in transplanted and healthy subjects, respectively, without significant differences between these groups. Meyer et al 24 , working with a load of 50 watts, reported a VO 2 of 0.96 ±0.1 and 0.95±0.08 L/min -1 in transplanted and control subjects, respectively.The reduction of peak VO 2 is due to multiple factors, both central and peripheral. Chronotropic incompetence and alteration in diastolic function are central factors 21,22,25,26 . At the peripheral level, reduction of peripheral oxygen extraction occurs 17,21,22,[27][28][29] . An exaggerated neuroendocrine response 19 and reduced capacity of pulmonary diffusion 20,30 also seem to be involved in decreased tolerance to exercise.Heart Rate -Heart rate values at rest have been observed to be higher in transplanted compared with healthy individuals due to the absence of parasympathetic innervation and corresponding to the intrinsic frequency of the sinus node 17,23,[31...

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“…CAV diagnosis is still based upon invasive methods, in particular selective coronary angiography, intravascular ultrasound (IVUS) (2) and coronary flow reserve (CFR) by intracoronary Doppler flow wire (3). Several noninvasive tests have proven unsatisfactory (4).…”

Section: Introductionmentioning

confidence: 99%

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Tona

Caforio

Montisci

et al. 2006

American Journal of Transplantation

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Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrastenhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50 ± 12 years at HT), at 8 ± 4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of ≤2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3 ± 0.7 vs. 3.2 ± 0.5, p < 0.0001). The ≤2 cut point was 100% specific and 38% sensitive. The ≤2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard ≤2 cut point to 85% with the optimal cut point of ≤2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated.

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Insensitivity of noninvasive tests to detect coronary artery vasculopathy after heart transplant

Cited by 188 publications

References 16 publications

Analysis of the risk factors for allograft vasculopathy in asymptomatic patients after cardiac transplantation

Analysis of the risk factors for allograft vasculopathy in asymptomatic patients after cardiac transplantation

Adaptation to exercise following cardiac transplantation

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

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