Istituto di Fisiologia Clinica     
Ciliberto G. R., Parodi O., Cataldo G., Mangiavacchi M., Alberti A., Parolini M., Frigerio M. Prognostic value of contractile response during high-dose dipyridamole echocardiography test in heart transplant recipients. In: Journal of Heart and Lung Transplantation, vol. 40 pp. 491 - 499. Elsevier Inc, 2003.
Background: Coronary allograft vasculopathy (CAV) remains a main factor limiting long-term survival after heart transplantation (HTX). The diagnosis of CAV is still based on serial coronary angiography. In this study, we evaluated the prognostic value of high-dose dipyridamole echocardiography in HTX. Methods: Sixty-eight patients underwent dipyridamole echocardiography within 48 hours of their scheduled annual coronary angiography. Coronary allograft vasculopathy was defined as CAV 1 (focal or diffuse stenosis <50%) or CAV 2 (focal or diffuse stenosis ≥50%). Wall-motion score index (WMSI) was evaluated at rest and after dipyridamole administration. Results: Results of coronary angiography were normal in 43 patients (63%), showed CAV 1 in 11 (16%), and showed CAV 2 in 14 (21%). Rest wall motion was normal in 39 patients and abnormal in 29. After dipyridamole administration, wall motion remained normal in all 39 (Group 1, no CAV in 34 and CAV 1 in 5). Of 29 patients with rest wall-motion abnormalities, all reversed to normal after dipyridamole in 8 patients (Group 2, no CAV in 7 and CAV 1 in 1) and remained or worsened in 21 (Group 3, CAV 2 in 14 and no CAV or CAV 1 in 7). During follow-up (6 3 years), 15 patients had major cardiac events: 11 occurred in Group 3, whereas 4 occurred in Groups 1 and 2. Wall motion at rest and after dipyridamole administration and CAV were independent predictors for cardiac events; only dipyridamole WMSI >1 remained significant (p < 0.0001) at multivariate analysis. Conclusions: Dipyridamole echocardiography is a simple, non-invasive test that after HTX may identify patients with altered wall motion who deserve stricter surveillance.
URL: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6VSG-48HWVKW-6-3&_cdi=6262&_user=10&_orig=search&_coverDate=05%2F31%2F2003&_qd=1&_sk=999779994&view=c&wchp=dGLbVtz-zSkWA&md5=25add8e367dfc6ba3830eeb40f6eda6e&ie=/sdarticle.pdf
Subject Prognostic value

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