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European Journal of Echocardiography Advance Access originally published online on October 9, 2007
European Journal of Echocardiography 2008 9(4):494-500; doi:10.1016/j.euje.2007.08.006
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Quantitative assessment of cardiac allograft vasculopathy by real-time myocardial contrast echocardiography: a comparison with conventional echocardiographic analyses and [Tc99m]-sestamibi SPECT

Marcus Hacker2,5, Hans X. Hoyer1,2,5, Christopher Uebleis2, Peter Ueberfuhr3, Stefan Foerster2, Christian La Fougere2 and Hans-Ulrich Stempfle1,4,*

1 Department of Cardiology, Medizinische Poliklinik, Innenstadt, University of Munich, Ziemssenstrasse 1, 80336 Munchen, Germany
2 Department of Nuclear Medicine, University of Munich, Germany
3 Department of Cardiac Surgery, University of Munich, Germany
4 Department of Cardiology, Asklepios Stadtklinik Bad Tölz, Germany

Received 22 May 2007; accepted after revision 15 August 2007; online publish-ahead-of-print 9 October 2007.

* Corresponding author: Department of Cardiology, Asklepios Stadtklinik Bad Tölz, Germany. Tel: +49 08041 507 1221; fax: +49 08041 507 1223. E-mail address: u.stempfle{at}asklepios.com (H.-U. Stempfle).


  Abstract

Aim: To evaluate the additional benefit of visual and quantitative perfusion measurements compared with conventional real-time myocardial contrast echocardiography (MCE) in the detection of CAV.

Methods and results: Thirty patients (26 males, age 58 ± 9.6 years) underwent dobutamine stress echocardiography (DSE) and myocardial perfusion imaging (MPI) as well as coronary angiography (CA) with intravascular ultrasound (IVUS). Ultrasound images were analysed off-line, evaluating (1) wall motion and thickening at high mechanical index (‘conventional evaluation’), (2) the MCE loops stored during continuous infusion of contrast agent with regard to visual changes (stress vs. rest, ‘visual grading’), and (3) the replenishment curves of the contrast agent at low mechanical index after bubble destruction (‘quantitative grading’). CA/IVUS plus MPI showed ischaemia in seven and myocardial scars in nine patients. Sensitivity, specificity, NPV, PPV and accuracy for the detection of ischaemia representing functionally relevant CAV were, respectively, 0.71, 0.83, 0.90, 0.55 and 0.80 for the conventional evaluation alone, 0.71, 0.91, 0.91, 0.71 and 0.87 for additional visual grading and 0.86, 0.91, 0.95, 0.75 and 0.90 for additional quantitative grading.

Conclusion: Real-time MCE including visual and quantitative analysis is feasible for screening patients after HTX and is highly accurate in the diagnosis of haemodynamically relevant CAV.

Keywords: Cardiac allograft vasculopathy; Contrast echocardiography; Myocardial perfusion imaging; Heart transplantation

5 Drs Hacker and Hoyer share equally the authorship of this paper.


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