Coronary Vasculopathy Research Articles

Effect of High-Intensity Interval Training on Progression of Coronary Artery Vasculopathy in De Novo Heart Transplant Recipients

Purpose Coronary artery vasculopathy (CAV) leads to increased morbidity and mortality in heart transplant (HTx) recipients. We have previously shown that high-intensity interval training (HIT) in maintenance recipients significantly reduced CAV progression, as compared to a control group. Our hypothesis was that HIT compared to moderate intensity, continuous training (MICT) in de novo HTx recipients would show similar results. Methods 67 HTx recipients (mean ± SD age 49 ± 13, 72 (% men) were randomized to either nine months of HIT or MICT at mean 11 weeks (range 7 - 16) post HTx. The effect of training on CAV progression was assessed by matched intravascular ultrasound (IVUS) examinations at baseline and 12 months, and analyses were performed to measure change in Maximal Intimal Thickness (MIT), Percent Atheroma Volume (PAV) and Total Atheroma Volume (TAV). Results Age and sex were similar between the groups. Peak oxygen consumption (VO2peak L/min) improved with 12.5 ± 10.3 % in the HIT group vs. 8.7 ± 9.3 % in the MICT group (p=0.022). IVUS analysis revealed a relatively small increase in all the three main IVUS parameters in both groups: The mean ± SD increase in MIT was 0.08 ± 0.12mm in the HIT group vs. 0.06 ± 0.10 mm in the MICT group. The increase in PAV was 4.3 ± 5.6 % in the HIT group vs. 3.2 ± 3.9 % in the MICT group, and TAV increased with 20.0 ± 51.5 mm3in the HIT group vs. 25.7 ± 44.8mm3 in the MICT group, but there were no significant differences between the groups (see Table 1). Furthermore, there were no significant correlations between VO2peak and MIT, PAV or TAV in either of the groups. Conclusion The increase in VO2 peak was significantly greater in HIT patients as compared to the MICT group. However, there was no significant difference in progression of CAV between the two treatment groups. We await the results from the 3-year follow-up to evaluate potential long-term effects.

Heterogenerous Outcomes of Liver Disease after Heart Transplantation for a Failed Fontan Procedure

Purpose Hepatic fibrosis and cirrhosis have been recognized as complications after the Fontan procedure, which may preclude heart-only transplantation (HT). We and others have reported successful short-term survival for HT but to date the fate of the liver after HT is unknown. We hypothesized that HT would lead to reversal of hepatic pathology in the failed Fontan HT recipient. Methods Pre- and post-HT liver imaging by CT scan or MRI were evaluated and classified as 1) no pathology, 2) fibrosis/congestive hepatopathy (F/CH), and 3) cirrhosis by the same evaluator in a similar fashion to our previous analysis. Congestive hepatopathy and early fibrosis were analyzed as one group, as differentiating between the two entities with conventional imaging is challenging. Transaminases, total bilirubin, serum albumin, and INR were measured routinely as part of post-HT surveillance. Results 13 HT recipients for failed Fontan procedure were evaluated: 5 had normal findings (Group A) and 8 [F/CH-6, cirrhosis-2] were abnormal at transplant (Group B). Median age at HT were 8.9 yr (7.5 - 19.8 yr) for Group A and 8.6 yr (4.7-19.2 yr) for Group B. None of the subjects in either group developed abnormalities of serum liver studies or overt liver failure. All patients with F/CH at time of HT had resolution of F/CH post-HT with a median follow-up time of scan of 28 mo (range 9.8-52 mo). Cirrhosis was persistent in one recipient scanned at 23 mo, but had resolved in the other when scanned 46 mo post-HT. 2 subjects in Group A developed liver disease: 1 with cirrhosis at 136 mo post-HT in association with PTLD and 1 with mild F/CH changes at 79 mo post-Tx in association with coronary vasculopathy. Conclusion This pilot study suggests liver disease as detected by conventional imaging in failed Fontan recipients generally resolves post-HT, but new onset liver disease can occur in recipients whose livers were normal at transplant. These findings need to be confirmed in a larger sample of recipients, but suggest all failed Fontan HT recipients should have ongoing surveillance for liver disease after HT regardless of pathology at time of HT.

Intensity of Statin Therapy Affects Progression of Coronary Artery Vasculopathy

Purpose Statin therapy offers long-term morbidity and mortality benefits after orthotopic heart transplant (OHT), regardless of lipid levels. Multiple statins have been specifically studied in post-OHT patients, showing decrease in dyslipidemia and development of cardiac allograft vasculopathy (CAV). CAV is an accelerated form of coronary artery disease characterized by concentric fibrous intimal hyperplasia along the length of coronary vessels. CAV is detectable by angiography in 43% of survivors in the first 8 years after OHT. Treatment with statins significantly reduces the incidence of transplant CAV and shows mortality benefit at ten years. This retrospective study examines the relationship between certain variables and the risk of developing CAV in a cohort of OHT patients at a single center. Methods Retrospective data points from 212 OHT patients at a single center were collected from the electronic medical record. For all patients, statin dosage was recorded as low, moderate, and high intensity based on the 2013 ACC/ AHA guidelines. Patient's yearly catheterization reports were reviewed for diagnosis of CAV. Time from OHT to CAV diagnosis was calculated from the date of the diagnosing catheterization. If a patient was diagnosed with CAV, data points including degree of CAV, systolic blood pressure, lipid levels, and HbA1c at the time of CAV diagnosis were recorded. Results Statin intensity was the only significant variable in the Cox Proportional Hazards model (p= 0.0025; HR = 1.49 (95% CI: 1.15-1.93). Similar models to predict rejection were considered, and no variables were found to be significant. A binary logistic regression model was run to predict the presence of any malignancy, and no variables were found to be significant at the 0.05 level. Elevated systolic blood pressure and HbA1c were also significant findings in the CAV group as compared to the non-CAV group of OHT patients (p=0.003 and p=0.035 respectively). Conclusion The intensity of statin therapy significantly affects the progression of CAV. OHT programs should be vigilant in prescribing their OHT patients statins and encouraging compliance due to the risk of life threatening complications. As well, as prescribing statins, patients should be monitored closely for hypertension and diabetes as these disease processes are more often found in patients with CAV, than those would do not have a CAV diagnosis.

Short-Term Outcome after Heart Transplantation is Comparable When Using Extended-Criteria Donors

Purpose The lack of donor organs limits the availability of heart transplantation as an optimal treatment option for advanced heart failure patients. In an effort to expand a pool of acceptable donor organs we explored a correlation between donor age and 1-year outcome in patients undergoing heart transplantation. Methods A retrospective cohort study was performed of all heart transplant reciepients at our center between 2006 and 2013. We reviewed the demographic, biochemical, transplant, donor and 1-year outcome data. An age threshold for extended criteria organs was set at 50 years. All patients received standard immunoinduction (basiliximab and steroids) and maintenance (CNI/MMF/steroids) immunosupression therapy. Results Of 133 patients 96 (72%) recieved non-extended criteria organ (Group A) and 34 (28%) recieved extended criteria organ (Group B). The two groups did not differ significantly regarding age (49.1±11.3 years in Group A vs. 51.9±6.4 years in Group B; P=0.1), male gender (72% vs. 82%;P=0.31), the presence of kidney dysfunction (31% vs. 18%; P=0.18), arterial hypertension (58% vs. 50%; P=0.44), diabetes (21% vs. 25%; P=0.69) and hyperlipidemia (40% vs. 50%; P=0.38). Also no differences were observed considering graft ischemic time (167±69 min vs. 195±64 min; P=0.07), donor norepinephrine vasoactive support (0,13±0,14 mcg/kg/min vs. 0,21±0,29 mcg/kg/min;P=0,07) and the nubmer of donor risk factors for coronary artery disease (0,8±0,9 vs. 1,0±1,1;P=0,18). Also the incidence of coronary vasculopathy (4% vs. 7%; P=0.63) and allograft rejection within first posttransplant year (10% vs. 7%;P=0.58) was not different between the two groups. Pre-explantation echocardiography was available in 100% in both groups. However, coronary angiography was used significantly more fequently in extened criteria organs (59±5% Group B vs. 11±3% Group A;P Conclusion Detailed evaluation of extended criteria donor organs may aid expand a pool of organs, available for transplantation without compromising short-term outcome of heart transplant receipients.

Metabolic Alterations, Aggressive Hormone-Naïve Prostate Cancer and Cardiovascular Disease: A Complex Relationship.

Background: Epidemiological studies suggest a possible relationship between metabolic alterations, cardiovascular disease and aggressive prostate cancer, however, no clear consensus has been reached. Objective: The aim of the study was to analyze the recent literature and summarize our experience on the association between metabolic disorders, aggressive hormone-naïve prostate cancer and cardiovascular disease. Method: We identified relevant papers by searching in electronic databases such as Scopus, Life Science Journals, and Index Medicus/Medline. Moreover, we showed our experience on the reciprocal relationship between metabolic alterations and aggressive prostate cancer, without the influence of hormone therapy, as well the role of coronary and carotid vasculopathy in advanced prostate carcinoma. Results: Prostate cancer cells have an altered metabolic homeostatic control linked to an increased aggressivity and cancer mortality. The absence of discrimination of risk factors as obesity, systemic arterial hypertension, diabetes mellitus, dyslipidemia and inaccurate selection of vascular diseases as coronary and carotid damage at initial diagnosis of prostate cancer could explain the opposite results in the literature. Systemic inflammation and oxidative stress associated with metabolic alterations and cardiovascular disease can also contribute to prostate cancer progression and increased tumor aggressivity. Conclusions: Metabolic alterations and cardiovascular disease influence aggressive and metastatic prostate cancer. Therefore, a careful evaluation of obesity, diabetes mellitus, dyslipidemia, systemic arterial hypertension, together with a careful evaluation of cardiovascular status, in particular coronary and carotid vascular disease, should be carried out after an initial diagnosis of prostatic carcinoma.

Getting to the Heart of Alzheimer Disease.

In a somewhat narrow diagnostic lens, Alzheimer disease (AD) has been considered a brain-specific disease characterized by the presence of Aβ (β-amyloid) plaques and tau neural fibrillary tangles and neural inflammation; these pathologies lead to neuronal death and consequently clinical symptoms, such as memory loss, confusion, and impaired cognitive function. However, for decades, researchers have noticed a link between various cardiovascular abnormalities and AD-such as heart failure, coronary artery disease, atrial fibrillation, and vasculopathy. A considerable volume of work has pointed at this head to heart connection, focusing mainly on associations between cerebral hypoperfusion and neuronal degradation. However, new evidence of a possible systemic or metastatic profile to AD calls for further analysis of this connection. Aβ aggregations-biochemically and structurally akin to those found in the typical AD pathology-are now known to be present in the hearts of individuals with idiopathic dilated cardiomyopathy, as well as the hearts of patients with AD. These findings suggest a potential systemic profile of proteinopathies and a new hypothesis for the link between peripheral and central symptoms of heart failure and AD. Herein, we provide an overview of the cardiovascular links to Alzheimer disease.

Non-Invasive Assessment of Coronary Microcirculation in Heart Transplantation

Heart transplantation (HT) is an accepted treatment for end-stage heart failure (HF). Heart transplantation significantly increases survival, exercise capacity, quality of life and return to work in selected patients with advanced heart failure compared with conventional treatment. The survival rates have improved with the use of new immunosuppressive drugs, with a median survival after transplantation of approximately 11 years. The shortage of donor hearts represents a major limitation in this field. In addition many are the consequences of the limited effectiveness and complications of immunosuppressive therapy (i.e. antibody-mediated rejection, infection, hypertension, renal failure, malignancy and coronary artery vasculopathy). In particular, chronic rejection may occur months to years after the transplantation and is referred to as cardiac allograft vasculopathy (CAV). CAV occurs in 32% of the patients after 5 years and ensuing allograft failure from CAV eventually accounts for 30% of recipient deaths after transplantation. Cardiac allograft vasculopathy, involving coronary macro- and microcirculation, is caused by complicated interplay between immunologic and non-immunologic factors resulting in repetitive endothelial injury and localized sustained inflammatory response. Early diagnosis of microvascular dysfunction is substantial. In this review we analyze signs and symptoms of CAV presentation and the different methodologies to achieve an early and precise diagnosis. We will discuss invasive and non-invasive diagnostic tools and their specific role in evaluating graft’s function, morphology, the presence of coronary artery disease and possible microcirculation involvement.

Heart and heart-liver transplantation in adults with failing Fontan physiology.

As the population of patients with a Fontan palliation grows so does, the number of patients with cardiac failure necessitating orthotopic heart transplant (OHT) and combined heart-liver transplant (CHLT). There is recent evidence that current era cardiac transplant in Fontan patients has improved outcomes, but most studies have a preponderance of pediatrics patients in their cohorts. We examine our institutional experience with adult OHT and CHLT transplantation for failed Fontan physiology. Retrospective analysis of patients at the Ahmanson/UCLA Adult Congenital Heart Disease Center who underwent OHT or CHLT for failing Fontan physiology from January 1, 2002 to May 31, 2017. We identified 20 patients with single-ventricle physiology and Fontan palliation who underwent OHT or CHLT. The median age was 29.5years (range 19-44). Five patients underwent CHLT because of biopsy proven hepatic cirrhosis. The median length of hospital stay was 23days (range 8-76) post-OHT and 51 days (range 26-77) post-CHLT. During a median follow-up of 56months (range 2-178), there was one mortality occurring at 34months post-OHT due to coronary vasculopathy. Most frequent early postoperative complications included bleeding and infection (55% and 20%, respectively) and surgical reintervention for bleeding complications (n=8, 40%). One CHLT patient experienced clinically significant hepatic rejection requiring admission and steroid treatment. Despite inherent risks and complexities of OHT or CHLT in patients with a failed Fontan, transplant is a reasonable therapy. Peri- and postoperative complications are common and may require surgical reintervention. Continued observation of practices and unifying themes may help improve patient selection, pre- and postoperative treatment and ultimately outcomes.

Tissue-associated self-antigens containing exosomes: Role in allograft rejection

Exosomes are extracellular vesicles that express self-antigens (SAgs) and donor human leukocyte antigens. Tissue-specific exosomes can be detected in the circulation following lung, heart, kidney and islet cell transplantations. We collected serum samples from patients who had undergone lung (n = 30), heart (n = 8), or kidney (n = 15) transplantations to isolate circulating exosomes. Exosome purity was analyzed by Western blot, using CD9 exosome-specific markers. Tissue-associated lung SAgs, collagen V (Col-V) and K-alpha 1 tubulin (Kα1T), heart SAgs, myosin and vimentin, and kidney SAgs, fibronectin and collagen IV (Col-IV), were identified using western blot. Lung transplant recipients diagnosed with bronchiolitis obliterans syndrome had exosomes with higher expression of Col-V (4.2-fold) and Kα1T (37.1-fold) than stable. Exosomes isolated from heart transplant recipients diagnosed with coronary artery vasculopathy had a 3.9-fold increase in myosin and a 4.7-fold increase in vimentin compared with stable. Further, Kidney transplant recipients diagnosed with transplant glomerulopathy had circulating exosomes with a 2-fold increased expression of fibronectin and 2.5-fold increase in Col-IV compared with stable. We conclude that circulating exosomes with tissue associated SAgs have the potential to be a noninvasive biomarker for allograft rejection.

Using the Theory of Planned Behavior to Explore Pediatric Heart Transplant Recipients’ Dietary Behavior

Abstract. Heart transplantation is the treatment of choice for children with end-stage heart disease. Coronary artery vasculopathy is, however, a significant morbidity and leading cause of late graft loss, and hyperlipidemia a risk factor for its development. Improving diet in this population could have important benefits for patients. We wanted to understand what influences decisions about food intake in this patient group. Dietary intentions and behavior were examined using a questionnaire based on the Theory of Planned Behavior (TPB) with 67 children who had undergone heart transplantation at least 12 months previously. The TPB model was significant for both healthy and unhealthy dietary behaviors, explaining 55% and 38% of the variance, respectively. Ten percent of children reported not eating any fruit and/or vegetables in the previous week and only 29% reported eating fruit and/or vegetables every day. The Theory of Planned Behavior provides a framework for explaining some specific dietary behaviors related to individual food groups in children who have undergone heart transplantation. These preliminary data support using this approach to inform the development of interventions to improve fruit and vegetable consumption but the approach may be less useful for explaining and developing interventions to reduce the consumption of unhealthy foods.

Low AlloMap Variability Score Within the First 3 Years Post Heart Transplant is Associated with the Combined Endpoint of Death, Malignancy and Coronary Vasculopathy Post Heart Transplant

Low AlloMap Variability Score Within the First 3 Years Post Heart Transplant is Associated with the Combined Endpoint of Death, Malignancy and Coronary Vasculopathy Post Heart Transplant

Complement (C1q) Binding De Novo Donor-Specific Antibodies and Cardiac-Allograft Vasculopathy in Pediatric Heart Transplant Recipients.

We hypothesized C1q binding de novo donor-specific antibody (DSA) after heart transplant (HT) is a higher risk for development of coronary artery vasculopathy (CAV) in children. A retrospective analysis of 127 pediatric HT recipients transplanted between January 2005 and December 2014 was used to determine complement (C1q)-binding de novo DSA on the outcomes of HT and the ability of the C1q assay to predict CAV development. Of 127 patients, 59 (46.4%) developed de novo DSA, 37 of those had C1q+ DSA. There was no difference in baseline characteristics except patients who developed C1q+ DSA more often received a donor heart from a female compared with C1q- DSA group (P = 0.034). The DSA median fluorescent intensity (MFI) value of 7000 or greater had 80% sensitivity and 80% specificity (C statistics 0.89, P <0.05) for predicting positive C1q binding. Multivariate analyses identified C1q binding DSA as an independent risk for CAV with a hazard ratio (HR) of 3.25 (95% confidence interval [CI], 1.33-7.93; P = 0.0095). In multivariable Cox proportional hazard models, the covariates associated with graft loss included: C1q+ DSA (HR, 3.2; 95% CI, 1.34-7.86; P < 0.009), pre-HT renal insufficiency (HR, 11.3; 95% CI, 3.71-34.29; P < 0.0001), and pre-HT ventilator support (HR, 3.3; 95% CI, 1.39-7.81; P = 0.007). The DSA strength in MFI correlates with positive C1q-binding activity and hence functional capabilities of DSA. Close monitoring of DSA strength in MFI and function (C1q assay) may be useful for identifying pediatric HT recipient at risk for development of CAV.

ANTIBODY MEDIATED REJECTION SIXTEEN YEARS POST CARDIAC TRANSPLANTATION: AN UNCOMMON LATE PRESENTATION

Late antibody-mediated rejection (AMR) over 10 years post heart transplant (OHT) is rare but associated with coronary artery vasculopathy (CAV), high mortality and graft dysfunction. A 50-year-old woman 16 years post OHT presented with 3 weeks of dyspnea. Last protocol-driven biopsy 12 years prior

Percutaneous coronary intervention versus coronary artery bypass grafting in heart transplant recipients with coronary allograft vasculopathy: a systematic review and meta-analysis of 1,520 patients.

Transplant coronary artery vasculopathy (TCAV) is the major cause of late allograft failure and death in heart transplant recipients. The aim of this systematic review was to examine the outcomes of percutaneous coronary interventions (PCIs) as compared to coronary artery bypass grafting (CABG) surgery in the management of TCAV. Our secondary objective was to compare the use and outcomes of drug eluting stents (DES) as compared to bare metal stents (BMS) in this patient population. Electronic search was performed to identify all studies in the English literature examining PCI as compared to CABG for TCAV in heart transplant recipients. All identified articles were systematically assessed for inclusion and exclusion criteria. Of the 4,989 studies identified, 29 studies were included. Among 1,520 patients who developed TCAV, 1,470 patients underwent PCI and 50 patients underwent CABG. There were no significant differences in baseline demographics and comorbidities among the PCI and CABG cohorts. Compared to the PCI cohort, patients who underwent CABG had a higher early mortality (CABG 36.4% vs. PCI 4.3%, P<0.001) and overall mortality (CABG 42.3% vs. PCI 21.4%, P=0.049). When comparing DES versus BMS cohorts, there were no significant differences in the rate of in-stent stenosis (DES 14.5% vs. BMS 24.4%, P=0.476), overall mortality (DES 17.4% vs. BMS 30.8%, P=0.302) or cardiac related mortality (DES 7.7% vs. BMS 21.8%, P=0.415). CABG and PCI are both feasible modalities for revascularization in patients with TCAV where PCI is associated with lower mortality. There were no differences in outcomes among patients who underwent PCI with DES as compared to BMS. Potential bias may exist due to heterogeneity in available data. Further studies are needed to delineate evidence-based guidelines to tailor the appropriate therapy, CABG or PCI, to the appropriate patient.

Graft vasculopathy in a Wistar rat model of heterotopic heart transplantation depending on gender matching between donors and recipients.

IntroductionHeart transplant is an accepted treatment modality in end-stage heart failure. The graft coronary artery vasculopathy is a main concern to explain the heterogeneity of the rejection process according to the gender of the donor and recipient.AimTo assess the severity and type of mechanisms leading to failure of the graft.Material and methodsExperimental allogenic heart transplantation in the abdomen was performed on Wistar rats depending on the gender of the donor and recipient (F – female; M – male) in four groups (FF, FM, MM MF). The donor heart was implanted in the abdominal cavity of the recipient. Complete time of observation was 10 weeks. Bromodeoxyuridine was administered intraperitoneally to detect proliferating cells.ResultsThere was 42.5% graft survival in all experiments. The mean time of graft survival was 60 ±18, 54 ±29, 58 ±23 and 64 ±18 days (FF, FM, MM and MF) and no significant difference was found in graft survival time among the four experimental groups (p = 0.73). None of the heart weight changes reached statistical significance.ConclusionsThe use of an animal experimental model helps to understand the mechanisms leading to graft failure and to compare the changes that occur in rats to human hearts. The gender matching affects the survival of the transplanted heart and severity of the graft vasculopathy.

Myocardial Fistulisation and Coronary Arterial Ectasia in Children with Univentricular Circulation: An Under-Recognised Problem.

Among 241 children with univentricular circulation who underwent total cavopulmonary connection (Glenn or Fontan) over a 17years period (January 2000-April 2017), we found two patients who had diffuse coronary fistulisation of their myocardium (0.8%). We also report an additional third case from Oak Lawn, Illinois, USA. One of the children had documented normal coronary arteries and myocardium at catheterisation prior to development of the fistulisation process. The same child also developed extensive veno-venous collaterals. All children had evidence of elevated pulmonary arterial pressures and were treated with a combination of pulmonary vasodilators. The presence of chronic hypoxaemia and elevated filling pressures could potentially have contributed to coronary endothelial dysfunction, thereby giving rise to the coronary vasculopathy and myocardial fistulisation. Alternatively, this myocardial fistulisation process may be present from early in life and not recognised. This may necessitate early referral for orthotopic cardiac transplantation. Diffuse fistulisation of the myocardium in children and young adults with univentricular circulation may be an under-recognised occurrence and coronary angiography should be considered in these patients.

Worsening in Longitudinal Strain and Strain Rate Anticipates Development of Pediatric Transplant Coronary Artery Vasculopathy as Soon as OneYear Following Transplant.

Transplant coronary artery vasculopathy (TCAV) following orthotopic heart transplantation (OHT) continues to be the primary reason for late graft failure in children. The current gold standard of diagnosis of TCAV is coronary angiography with or without intravascular ultrasound. This study investigates the longitudinal use of speckle-tracking echocardiographic strain imaging as an early non-invasive marker to screen for development of TCAV. Echocardiograms from patients who underwent OHT between 2006 and 2010 at Children's Hospital Colorado (n=50) were retrospectively assessed. Studies were evaluated at baseline (within a month of transplant), then at each annual clinical follow-up for peak longitudinal (LS) and circumferential (CS) strain, systolic strain rate, and diastolic strain rate using Siemens Velocity Vector Imaging software. Comparisons were made between subjects who did and did not develop TCAV. Mean time to TCAV diagnosis following OHT was 3.2years (range 1-5.1years). One year after transplant, significant differences were seen between groups in LS (non-TCAV mean -19.6%, TCAV mean -17.3%, p=0.03) and longitudinal strain rate (non-TCAV mean -1.7%/s, TCAV mean -1.4%/s, p=0.04). These differences persisted in subsequent years. Differences in LS preceded the catheterization-based diagnosis of TCAV in pediatric heart recipients and were noted as early as one year post transplant. Additionally, within-subject LS changes may have utility as a non-invasive screening tool to predict those patients at increased risk for development of TCAV.

Stress echocardiography: An overview for use in pediatric and congenital cardiology.

Currently, the role of stress echocardiography primarily resides in diagnosing acquired coronary artery disease (CAD) in adults. Besides an increasing concern for traditional CAD in young patients due to obesity and other chronic pediatric diseases, there is also a growing population of adolescents and young adults with "at risk" coronary arteries due to: reimplanted coronaries in congenital heart disease, anomalous origin of the native coronary arteries, coronary abnormalities in Kawasaki's disease, and posttransplant coronary vasculopathy. Stress echocardiography is well suited for routine screening and monitoring in these patients. Also, due to the ability of stress echocardiography to provide real-time cardiac imaging, it is useful in areas beyond coronary ischemia. Utilizing Doppler derived velocities and pressure gradients, one is able to further evaluate and risk-stratify patients with valvular heart disease. In addition, stress echocardiography is useful in evaluating other areas including ventricular and coronary reserve. The benefits of stress echocardiography are it is: readily available, portable, and relatively cheap. It can be performed without sedation or radiation exposure which becomes very important in younger patients that require periodic monitoring. Stress echocardiography can also evaluate functional abnormalities instead of relative perfusion defects. Overall, stress echocardiography is currently an underutilized imaging modality that has a wide, and expanding, range of application in the practice of pediatric and congenital cardiology.

(897) - Can We Use Tissue Doppler Imaging to Screen for Cardiac Allograft Rejection and Coronary Vasculopathy?

(897) - Can We Use Tissue Doppler Imaging to Screen for Cardiac Allograft Rejection and Coronary Vasculopathy?

(713) - Echocardiographic Measurements of Longitudinal Strain Decrease with the Development of Coronary Vasculopathy in Pediatric Heart Transplant Recipients

(713) - Echocardiographic Measurements of Longitudinal Strain Decrease with the Development of Coronary Vasculopathy in Pediatric Heart Transplant Recipients