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Purpose: Cardiac allograft vasculopathy (CAV) is the most important cause of late mortality among cardiac allograft recipients. Dobutamine stress echocardiography (DSE) is considered a safe and cost-effective method to screen these patients who remain free of angina most of the time. We evaluated DSE results in a series of cardiac allograft recipients., Methods: The DSE was performed on a yearly basis. From 2004 to 2006, twelve DSEs were performed on 8 patients, including 7 men, and overall mean age of 36 +/- 12 years. Dobutamine infusion begun at 5 microg/kg/min was titrated at 3-minute stages to 10, 20, 40, and 50 microg/kg/min to achieve the target heart rate. In addition, at every stage, we performed a 12-lead EKG, heart rate, and blood pressure recording. The DSE results were compared with coronary angiograms and endomyocardial biopsies., Results: Two patients displayed mildly and 1 patient a severely abnormal DSE test. The severely abnormal DSE test was associated with severe coronary artery stenosis, including inexperiment of the left main coronary artery. The second patient with an abnormal DSE had contour irregularities and distal cut-off of the right coronary artery as well as 2R cellular rejection. The third patient had a normal angiogram and no rejection. None of the patients with normal DSE experienced a cardiac event, coronary lesions, or rejection., Conclusion: Use of DSE appears to be a sensitive method to detect CAV in asymptomatic recipients. However, mild wall motion abnormalities can be detected in patients without stenosing coronary lesions. The value of DSE in predicting CAV must be examined in larger series with long-terms of follow-up. more...

Purpose: Our objective was to determine the most relevant systolic and diastolic echocardiographic parameters to detect left ventricular (LV) dysfunction associated with allograft rejection among heart transplant recipients., Patients and Methods: Seven consecutive recipients underwent serial echocardiographic studies with two-dimensional spectral Doppler and tissue Doppler (TD) according to our institutional protocol. Results were compared with clinical status and endomyocardial biopsies (EMB) whenever available., Results: The time since transplantation was 22 to 850 days. Patient no. 2 had a biopsy-proven acute rejection at the 11th week which was associated with decreased TD velocities, ejection fraction (EF), and stroke volume (SV), as well as increased pericardial effusion and posterior wall thickness. Interestingly, changes in TD parameters preceded those in EF and SV. However, similar but less remarkable changes in TD velocities, EF, SV, pericardial effusion, and posterior wall thickness also occurred during other events, such as systemic infection and immediate postoperative hemodynamic compromise despite no rejection. A biopsy performed 7 months later in a patient with a previous rejection episode due to a relatively low EF and SV as well as increasing pericardial effusion with normal TD velocities revealed no rejection., Conclusions: These data suggest that echocardiographic findings, although not specific for acute rejection, may play a potential role as a screening test to exclude rejection in heart transplant recipients. more...