Noninvasive tests can detect coronary allograft vasculopathy

המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-24 13:50:07 EDT (Reuters Health)

LONDON (Reuters Health) – The combination of echocardiography and high-dose dipyridamole technetium-99m sestamibi tomography (SPECT) provides a safe and cost-effective strategy for detecting coronary vasculopathy in transplant patients, Italian researchers report.

Dr. Guglielma R. Ciliberto from the Niguarda Ca' Granda Hospital in Milan and colleagues studied 78 consecutive heart transplant patients within 48 hours after completion of a yearly angiogram. The patients also underwent echocardiography while at rest and high-dose dipyridamole technetium-99m SPECT.

Results of the angiograms showed that 53 patients had no signs of coronary allograft vasculopathy, 13 patients had one coronary allograft vasculopathy lesion and 12 patients had two coronary allograft vasculopathy lesions, according to the report in the June issue of the European Heart Journal.

The combined noninvasive tests identified normal wall motion in 69 patients and significant abnormal wall motion in 9 patients. In addition, dipyridamole technetium-99m sestamibi scans were normal in 58 patients and abnormal in 20 patients, the researchers report.

Dr. Ciliberto's group found that echocardiography correctly identified 96% of the patients with normal regional wall motion with non-coronary allograft vasculopathy or one coronary allograft vasculopathy lesion. In addition, positive dipyridamole technetium-99m sestamibi scan correctly identified 92% of patients with significant coronary lesions.

The use of this combination noninvasive strategy would have resulted in deferral of coronary angiography for 54 patients with concordant negative echocardiography and SPECT, and the performance of coronary angiography in five patients with concordant positive tests and in 19 patients with discordant results, the researchers note.

The investigators calculate that this strategy would have an average cost of 1260 Euro dollars, providing a cost savings of an average of 624 Euro dollars. Based on a yearly case load of 35 new heart transplant patients who normally undergoing angiography, the use of these noninvasive tests could result in an average cost savings of 1014 Euro dollars for each negative result and 906 Euro dollars for each positive coronary allograft vasculopathy, Dr. Ciliberto's group concludes.

"The encouraging results by Dr. Ciliberto, et al. should be an incentive for more transplant centers to start parallel routine noninvasive imaging," Dr. U. Sechtem from Robert Bosch Krankenhaus in Stuttgart, Germany, comments in a journal editorial.

"If the good results of noninvasive imaging are confirmed," Dr. Sechtem adds, "routine care for the post transplant patient may become less of a burden both for the patients and for society."

Eur Heart J 2001;22:895-897,964-971.

-London Newsroom +44 20 7542 7986

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