Dobutamine Stress Echocardiography in Heart Transplant Recipients' Evaluation: The Role of Reinnervation

Abstract

Introduction Orthotopic heart transplantation renders the recipient denervated. This remodeling of the intrinsic cardiac nervous system should be taken in account during functional evaluation for allograft coronary artery disease. Dobutamine stress echocardiography (DSE) has been used to detect patients at greater risk. The aim of this study was to determine whether patients with various autonomic response levels, and supposed reinnervation patterns, show the same response to DSE. Methods We studied 20 patients who had survived more than 5 years after orthotopic heart transplantation. All patients underwent a Holter evaluation. We considered patients with low variability to be those with less than a 40-bpm variation from the lowest to highest heart rate, so-called “noninnenervated” (group NI). Patients who had 40-bpm or more variation were considered to show high variability and called “reinnervated” (group RI). After that, all patients performed an ergometric test and DSE. Results Groups were defined as NI ( n = 9) and RI ( n = 11). Ergometric tests confirmed this response with NI patients showing less variability when compared to RI patients ( P = .0401). During DSE, patients showed similar median heart rate responses according to the dobutamine dose. Spearmen correlation showed r = 1.0 ( P = .016). Conclusions DES was effective to reach higher heart rates, probably related to catecholamine infusion. These findings may justify a better response when evaluating cardiac allograft vasculopathy in heart transplant patients.