PHARMACOLOGIC MYOCARDIAL PERFUSION STRESS TESTING TO DETECT SIGNIFICANT CARDIAC ALLOGRAFT VASCULOPATHY: IS IT WORTHWHILE?

Abstract

Purpose Noninvasive testing to detect cardiac allograft vasculopathy (CAV) has had poor sensitivity and specificity. The use of stress-testing has not been found to be sensitive due to the denervated state of the donor heart due to poor heart rate response. Therefore, the use of intravenous medications such as dobutamine, persantine, and adenosine has been considered for the adequate stressing of the donor heart. We evaluated the utility of adenosine nuclear stress testing in detecting CAV at a single center. Methods Between January 1994 and March 2002, we reviewed 487 patients. Twenty-three patients were assessed for CAV by coronary angiography and adenosine nuclear tests that were obtained within 90 days from one another. We determined the ability of nuclear stress testing to accurately predict hemodynamically significant coronary lesions, defined as 70% angiographic stenosis. Results The adenosine nuclear stress test was able to detect significant CAV in only 6 of 19 patients with significant coronary lesions. The test thus had a sensitivity of only 31.5% but a specificity of 50%, a positive predictive value of 75%, and a negative predictive value of 13%. The adenosine nuclear study was also not effective in identifying patients with small vessel disease. Conclusions Even with pharmacologic stress, nuclear perfusion imaging is a poor substitute for coronary angiography for the detection of CAV. The limitation in heart transplant patients is more likely due to the diffuse nature of the disease. Diffuse three-vessel disease may produce balanced ischemia and consequently a false-negative study.