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Open Access Research

The pressure/volume relationship during dobutamine stress echocardiography in transplanted heart: comparison with quality of life and coronary anatomy

Giovanni Minardi1, Giordano Zampi1*, Amedeo Pergolini1, Giovanni Pulignano1, Massimiliano Scappaticci2, Francesca Moschella Orsini1, Gaetano Pero1, Paola Lilla Della Monica1, Giovanni Cioffi3 and Francesco Musumeci1

Author Affiliations

1 Department of Cardiovascular Science, Heart Transplant Center, “S. Camillo-Forlanini” Hospital, Circonvallazione Gianicolense, 87, Rome, 00151, Italy

2 Department of Cardiovascular Science, Catheterization Laboratory, “S. Camillo-Forlanini” Hospital, Rome, Italy

3 Department of Cardiology, Villa Bianca Hospital, Trento, Italy

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Cardiovascular Ultrasound 2012, 10:44  doi:10.1186/1476-7120-10-44

Published: 14 November 2012

Abstract

Background

Cardiac allograft vasculopathy (CAV) is a major late complication in cardiac transplant recipients and has a relevant impact on outcome of these patients. Aims of this study: to compare, in cardiac transplant recipients patients, the diagnostic value of pressure/volume relationship (ESPVR) during dobutamine stress echocardiography (DSE) for coronary artery disease, assessed by Multislice Computed Tomography (MSCT), and by coronary angiography (CA). We also analyzed any possible relationship between ESPVR and the Health Related Quality of Life of the patients (HRQoL), evaluated by SF–36 questionnaire.

Methods

25 consecutive patients underwent DSE within 24 hours after MSCT coronary angiogram and then they underwent CA. The HRQoL questionnaire was administered to the patients in the settings of DSE. They were followed-up for 6 months.

Results

DSE has a sensitivity in detecting CAV of 67%, specificity of 95%, positive predictive value of 67% and negative predictive value of 95%; DSE with ESPVR has a sensitivity of 100%, specificity of 95%, positive predictive value of 75%, negative predictive value of 100%; MSCT has a sensitivity of 100%; specificity of 82%; positive predictive value of 43%; negative predictive value of 100%. Htx recipients with a flat-biphasic ESPVR, although asymptomatic, perceived a worst HRQoL compared with the up-sloping ESPVR population, and this is statistically significant for the general health (p 0.0004), the vitality (p 0.0013) and the mental health (p 0.021) SF-36 subscale.

Conclusions

Evaluation with DSE and ESPVR is accurate in the clinical control of heart transplant recipients reserving invasive evaluation only for patients with abnormal contractility indexes.

Keywords:
Dobutamine stress echocardiography; Cardiac allograft vasculopathy; Coronary angiography; Multislice computed tomography