Heart Transplant Research Today is a free monthly online journal that collates and summarizes the latest research about Heart Transplant, including details on risks, prognosis, procedure, surgery, organ donation. | ||||||||
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Diagnostic and prognostic value of dobutamine thallium-201 single-photon emission computed tomography after heart transplantation.Wu YW, Yen RF, Lee CM, Ho YL, Chou NK, Wang SS, Huang PJ Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major cause of mortality in heart transplant recipients. We investigated the diagnostic and prognostic value of dobutamine thallium-201 ((201)Tl) single-photon emission computed tomography (SPECT) in heart transplant recipients. METHODS: We studied 47 patients (age 51.6 +/- 11.7 years, 37 men), at a mean of 34.0 +/- 21.4 months after heart transplant, who received dobutamine (201)Tl SPECT, echocardiography and coronary angiography within 1 month of each other. SPECT was considered abnormal in the presence of reversible or fixed defects in >/=2 segments. Significant CAV was defined as >/=50% luminal stenosis. RESULTS: Coronary angiograms were normal in 37 patients. Non-significant CAV was detected in 1 patient and significant CAV in 9 patients. The sensitivity, specificity, positive predictive value and negative predictive value of SPECT for the detection of significant angiographic CAV were 89%, 71%, 42% and 96%, respectively. Large reversible perfusion defects (>/=6 segments) always indicated significant CAV. In patients with normal left ventricular function, a lung/heart ratio (LHR) of >/=0.37 during stress was also an independent predictor of significant CAV (odds ratio 15.5, p = 0.04). A higher stress LHR was associated with greater vessel involvement (r = 0.516, p = 0.0002). Patients with impaired left ventricular function also had higher stress and resting LHR. Over 40.3 +/- 21.9 months after the first SPECT, 1 patient developed significant angiographic CAV and another 4 had cardiac death. Large reversible perfusion defect was a significant predictor of cardiac death (p = 0.002). CONCLUSIONS: Dobutamine (201)Tl SPECT is a useful method for detecting patients with significant CAV and assessing prognosis. It is reasonable and safe to design individualized surveillance intensity of coronary angiography for post-transplant patients on the basis of non-invasive monitoring of dobutamine (201)Tl testing. Published 17 May 2005 in J Heart Lung Transplant, 24(5): 544-50.
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