Dual-source CT coronary angiogram in heart transplant recipients in comparison with dobutamine stress echocardiography for detection of cardiac allograft vasculopathy
Stefano Mastrobuoni (1), Gorka Bastarrika (2), Matias Ubilla (1), Sara Castaño (3), Pedro Azcarate (3), Eduardo Alegria Barrero (3), Jose Maria Castellano (3), Jesus Herreros (1), and Gregorio Rabago (1)
(1) Department of Cardiovascular Surgery, Clínica Universitaria de Navarra, Universidad de Navarra, avenida Pio XII 36, 31008, Pamplona, Spain.
(2) Departament of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, avenida Pio XII 36, 31008, Pamplona, Spain.
(3) Department of Cardiology, Clínica Universitaria de Navarra, Universidad de Navarra, avenida Pio XII 36, 31008, Pamplona, Spain.
Conventional coronary angiography (CCA) is the gold standard in the diagnosis of cardiac allograft vasculopathy (CAV) in heart transplant recipients. Dobutamine stress echocardiography (DSE) is a useful technique for screening.
Dual-source computed tomography (DSCT) is the last generation of computed tomography scanners, which could be useful to noninvasively assess CAV. Thirty cardiac transplant recipients underwent DSE and DSCT coronary angiogram. Exclusion criteria were as follows: renal insufficiency, iodinated contrast media allergy, less than 12 months since transplant, and unstable clinical conditions. DSE showed ischemia in two patients. At DSCT scan 13 patients had a normal angiogram, 13 ones wall thickening and four significant diseases. DSCT showed a sensitivity of 100% with a specificity of 92%. DSCT allowed detection of more patients with CAV than DSE.
Four patients showed significant CAV at DSCT compared with two at DSE. Thirteen patients showed initial signs of disease at DSCT despite a normal DSE.
CITATION Transplantation. 2009 Feb 27;87(4):587-90