Feasibility of Real-Time Myocardial Contrast Echocardiography to Detect Cardiac Allograft Vasculopathy in Pediatric Heart Transplant Recipients - 03/05/21
, Steven C. Greenway, MD, MSc b, Sharon L. Mulvagh, MD c, d, Runqing Huang, PhD d, Shalon A. Maxon, RN d, Mary J. Hepinstall, RN d, Jason H. Anderson, MD d, e, Jonathan N. Johnson, MD d, eAbstract |
Background |
Cardiac allograft vasculopathy (CAV) is an important adverse prognostic factor for pediatric heart transplant (HT) recipients. Invasive coronary angiography (ICA) is the gold standard for CAV detection but lacks sensitivity for early microvascular changes and cumulative radiation exposure is of concern. Real-time myocardial contrast echocardiography (RTMCE) using ultrasound enhancing (contrast) agents performed during dobutamine stress echocardiography (DSE) can assess myocardial function, perfusion, and microvascular integrity. The objective of this study was to determine the safety and feasibility of RTMCE during DSE to detect CAV in a pediatric HT population.
Methods |
HT patients 10-21 years of age were recruited to undergo DSE with RTMCE to determine technical feasibility, test tolerability and adverse event rate, and detection of perfusion defects compared with ICA-detected CAV. Thirty-six patients from two centers were enrolled, with a mean age 13.5 ± 4.3 years; 21 (58%) were male. Wall motion and myocardial perfusion were qualitatively assessed and compared with ICA findings of CAV. Myocardial blood flow (MBF) at rest and peak stress was quantified, and myocardial blood flow reserve (MBFR) was defined as the ratio of peak to rest MBF.
Results |
Five (14%) patients had CAV by ICA, two with obstructive disease and three with mild CAV. Real-time myocardial contrast echocardiography was feasible in 32 (89%) patients. Three patients had wall motion defects, including one with a mixed defect and two with fixed defects. A perfusion abnormality was present in five patients, two of whom had obstructive CAV and one with mild CAV. Sensitivity and specificity of RTMCE for CAV detection were 60% and 94%, respectively, and diagnostic accuracy was 89%. MBFR assessment was feasible in 20 (63%) patients. The mean MBFR was 3.4 ± 0.7. Patients with CAV had lower MBFR than those without (2.0 ± 0.2 vs 3.7 ± 0.8; P < .01). There were no serious adverse events related to RTMCE.
Conclusions |
Dobutamine stress RTMCE appears to be safe and feasible for the assessment of CAV in pediatric HT recipients. Further assessment is warranted to determine whether this noninvasive technique could provide a reliable alternative to ICA.
Le texte complet de cet article est disponible en PDF.Highlights |
• | CAV causes significant morbidity in pediatric heart transplant recipients. |
• | CAV is difficult to detect by conventional noninvasive techniques. |
• | RTMCE during DSE was feasible and safe in 36 pediatric heart transplant recipients. |
• | Perfusion analysis identified CAV when compared with invasive coronary angiography. |
• | RTMCE may be a valuable approach to CAV screening in pediatric transplant patients. |
Keywords : Real-time myocardial perfusion echocardiography, Ultrasound enhancing agent, Pediatric, Heart transplant, Cardiac allograft vasculopathy
Abbreviations : CAV, DSE, HT, ICA, IVUS, LAD, LV, MBF, MBFR, MI, rBV, RTMCE, RWM, UEA
Plan
| Conflicts of Interest: N.M.F. has received speaker's honoraria from Lantheus Medical Imaging. S.L.M. has received honoraria for advisory board consultancy to Lantheus Medical Imaging. |
|
| This research was supported by a Mayo Clinic Transform the Practice Grant. This research was also supported by the Research Innovation Grant funded by the Canadian Society of Transplantation and jointly established by the Canadian Society of Transplantation and the Canadian Donation and Transplant Research Program. The ultrasound enhancing agent used for this research study, Definity, was provided by Lantheus Medical Imaging. |
Vol 34 - N° 5
P. 503-510 - mai 2021 Retour au numéro
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