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Dobutamine stress echocardiography after cardiac transplantation: implications of donor–recipient age difference

Echo Research & Practice volume 2, pages 65–71 (2015)Cite this article

Abstract

Dobutamine stress echocardiography (DSE) is widely used during follow-up after cardiac transplant for the diagnosis of allograft vasculopathy. We investigated the effect of donor–recipient age difference on the ability to reach target heart rate (HR) during DSE.

All cardiac transplant patients who were undergoing DSE over a 3-year period in a single institution were reviewed. Target HR was specified as 85%×(220–patient age). Further patient and donor demographics were obtained from the local transplant database.

61 patients (45 male, 55±12 years) were stressed with a median dose of 40mcg/kg per min dobutamine. Only 37 patients (61%) achieved target HR. Donor hearts were mostly younger (mean 41±14 years, P<0.001), with only 11 patients (18%) having donors who were older than they were. Patients with older donors required higher doses of dobutamine (median 50 vs 30mcg/kg per min, P<0.001) but achieved a lower percentage target HR (mean 93% vs 101%, P=0.003) than those with younger donors did. Patients with older donors were less likely to achieve target HR (18% vs 67%, P=0.003).

In conclusion, donor–recipient age difference affects the likelihood of achieving target HR and should be considered when a patient is consistently unable to achieve ‘adequate’ stress according to the patient’s age.

References

  1. Akosah KO, McDaniel S, Hanrahan JS, Mohanty PK 1998 Dobutamine stress echocardiography early after heart transplantation predicts development of allograft coronary artery disease and outcome. Journal of the American College of Cardiology 31 1607–1614. (doi:10.1016/S0735-1097(98)00169-7)

    Article  CAS  Google Scholar 

  2. Derumeaux G, Redonnet M, Mouton-Schleifer D, Bessou JP, Cribier A, Saoudi N, Koning R, Soyer R, Letac B 1995 Dobutamine stress echocardiography in heart transplant recipients. VACOMED research group. Journal of the American College of Cardiology 25 1665–1672. (doi:10.1016/0735-1097(95)00084-H)

    Article  CAS  Google Scholar 

  3. Spes CH, Klauss V, Mudra H, Schnaack SD, Tammen AR, Rieber J, Siebert U, Henneke KH, Uberfuhr P, Reichart B et al. 1999 Diagnostic and prognostic value of serial dobutamine stress echocardiography for non-invasive assessment of cardiac allograft vasculopathy: a comparison with coronary angiography and intravascular ultrasound. Circulation 100 509–515. (doi:10.1161/01.CIR.100.5.509)

    Article  CAS  Google Scholar 

  4. Mehra MR, Crespo-Leiro MG, Dipchand A, Ensminger SM, Hiemann NE, Kobashigawa JA, Madsen J, Parameshwar J, Starling RC, Uber PA 2010 International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for Cardiac Allograft Vasculopathy-2010. Journal of Heart and Lung Transplantation 29 717–727. (doi:10.1016/j.healun.2010.05.017)

    Article  Google Scholar 

  5. Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG, American Society of Echocardiography 2007 American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. Journal of the American Society of Echocardiography 20 1021–1041. (doi:10.1016/j.echo.2007.07.003)

    Article  Google Scholar 

  6. Flox A, Sanchez V, Delgado JF, Fernandez S, Tello R, Jimenez J, Garcia J, Gomez MA, Lombera F, Saenz de la Calzada C 2002 Is atropine infusion necessary to achieve the target heart rate in heart transplant patients during dobutamine stress echocardiography? Transplantation Proceedings 34 3241–3242. (doi:10.1016/S0041-1345(02)03619-9)

    Article  CAS  Google Scholar 

  7. Kociolek LK, Bierig SM, Herrmann SC, Labovitz AJ 2006 Efficacy of atropine as a chronotropic agent in heart transplant patients undergoing dobutamine stress echocardiography. Echocardiography 23 383–387. (doi:10.1111/j.1540-8175.2006.00223.x)

    Article  Google Scholar 

  8. Schinkel AF, Bax JJ, Geleijnse ML, Boersma E, Elhendy A, Roelandt JR, Poldermans D 2003 Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography? European Heart Journal 24 789–800. (doi:10.1016/S0195-668X(02)00634-6)

    Article  CAS  Google Scholar 

  9. Mastrobuoni S, Bastarrika G, Ubilla M, Castano S, Azcarate P, Barrero EA, Castellano JM, Herreros J, Rabago G 2009 Dual-source CT coronary angiogram in heart transplant recipients in comparison with dobutamine stress echocardiography for detection of cardiac allograft vasculopathy. Transplantation 87 587–590. (doi:10.1097/TP.0b013e318195a5a7)

    Article  Google Scholar 

  10. Bacal F, Abuhab A, Mangini S, Rodrigues AC, Fiorelli A, Stolf N, Bocchi E, Bellotti G, Ramires JA 2010 Dobutamine stress echocardiography in heart transplant recipients’ evaluation: the role of reinnervation. Transplantation Proceedings 42 539–541. (doi:10.1016/j.transproceed.2010.01.021)

    Article  CAS  Google Scholar 

  11. Tanaka H, Monahan KD, Seals DR 2001 Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology 37 153–156. (doi:10.1016/S0735-1097(00)01054-8)

    Article  CAS  Google Scholar 

  12. Gellish RL, Goslin BR, Olson RE, McDonald A, Russi GD, Moudgil VK 2007 Longitudinal modeling of the relationship between age and maximal heart rate. Medicine and Science in Sports and Exercise 39 822–829. (doi:10.1097/mss.0b013e31803349c6)

    Article  Google Scholar 

  13. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, Coke LA, Fleg JL, Forman DE, Gerber TC et al. 2013 Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 128 873–934. (doi:10.1161/CIR.0b013e31829b5b44)

    Article  Google Scholar 

  14. Bangalore S, Yao SS, Chaudhry FA 2006 Comparison of heart rate reserve versus 85% of age-predicted maximum heart rate as a measure of chronotropic response in patients undergoing dobutamine stress echocardiography. American Journal of Cardiology 97 742–747. (doi:10.1016/j.amjcard.2005.09.111)

    Article  Google Scholar 

  15. Shah BN 2013 On the 50th anniversary of the first description of a multistage exercise treadmill test: re-visiting the birth of the ‘Bruce protocol’. Heart 99 1793–1794. (doi:10.1136/heartjnl-2013-304003)

    Article  Google Scholar 

  16. Ciliberto GR, Ruffini L, Mangiavacchi M, Parolini M, Sara R, Massa D, De Maria R, Gronda E, Vitali E, Parodi O 2001 Resting echocardiography and quantitative dipyridamole technetium-99m sestamibi tomography in the identification of Cardiac Allograft Vasculopathy and the prediction of long-term prognosis after heart transplantation. European Heart Journal 22 964–971. (doi:10.1053/euhj.2000.2422)

    Article  CAS  Google Scholar 

  17. Sigurdsson G, Carrascosa P, Yamani MH, Greenberg NL, Perrone S, Lev G, Desai MY, Garcia MJ 2006 Detection of transplant coronary artery disease using multidetector computed tomography with adaptative multisegment reconstruction. Journal of the American College of Cardiology 48 772–778. (doi:10.1016/j.jacc.2006.04.082)

    Article  Google Scholar 

  18. Schepis T, Achenbach S, Weyand M, Raum P, Marwan M, Pflederer T, Daniel WG, Tandler R, Kondruweit M, Ropers D 2009 Comparison of dual source computed tomography versus intravascular ultrasound for evaluation of coronary arteries at least one year after cardiac transplantation. American Journal of Cardiology 104 1351–1356. (doi:10.1016/j.amjcard.2009.06.060)

    Article  Google Scholar 

  19. Pichler P, Loewe C, Roedler S, Syeda B, Stadler A, Aliabadi A, Schukro C, Wolf F, Zuckermann A, Lammer J et al. 2008 Detection of high-grade stenoses with multislice computed tomography in heart transplant patients. Journal of Heart and Lung Transplantation 27 310–316. (doi:10.1016/j.healun.2007.11.577)

    Article  Google Scholar 

  20. Muehling OM, Wilke NM, Panse P, Jerosch-Herold M, Wilson BV, Wilson RF, Miller LW 2003 Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging. Journal of the American College of Cardiology 42 1054–1060. (doi:10.1016/S0735-1097(03)00924-0)

    Article  Google Scholar 

  21. Rutz T, de Marchi SF, Roelli P, Gloekler S, Traupe T, Steck H, Eshtehardi P, Cook S, Vogel R, Mohacsi P et al. 2013 Quantitative myocardial contrast echocardiography: a new method for the non-invasive detection of chronic heart transplant rejection. European Heart Journal Cardiovascular Imaging 14 1187–1194. (doi:10.1093/ehjci/jet066)

    Article  Google Scholar 

  22. Tona F, Caforio AL, Montisci R, Gambino A, Angelini A, Ruscazio M, Toscano G, Feltrin G, Ramondo A, Gerosa G et al. 2006 Coronary flow velocity pattern and coronary flow reserve by contrast-enhanced transthoracic echocardiography predict long-term outcome in heart transplantation. Circulation 114 (1 Suppl) I49–I55. (doi:10.1161/CIRCULATIONAHA.105.001321)

    PubMed  Google Scholar 

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Acknowledgements

Dr H Becher is funded by an endowment from the Heart & Stroke Foundation of Alberta, Northwest Territories and Nunavut

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

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Authors and Affiliations

  1. Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK

    Patrick H. Gibson BMBCh MD

  2. Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada

    Fernando Riesgo MD, Jonathan B. Choy MD, Daniel H. Kim MD & Harald Becher MD

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  1. Patrick H. Gibson BMBCh MD
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  2. Fernando Riesgo MD
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Correspondence to Patrick H. Gibson BMBCh MD.

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Gibson, P.H., Riesgo, F., Choy, J.B. et al. Dobutamine stress echocardiography after cardiac transplantation: implications of donor–recipient age difference. Echo Res Pract 2, 65–71 (2015). https://doi.org/10.1530/ERP-15-0006

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  • DOI: https://doi.org/10.1530/ERP-15-0006

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Echo Research & Practice

ISSN: 2055-0464

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