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Revista chilena de cardiología

On-line version ISSN 0718-8560

Abstract

TORRES, Humberto et al. Comparison of coronary angiography and intra-coronary ultrasound as "gold standard" in the diagnosis of post cardiac transplantation vasculopathy. Rev Chil Cardiol [online]. 2011, vol.30, n.1, pp.47-51. ISSN 0718-8560.  http://dx.doi.org/10.4067/S0718-85602011000100007.

Background: Graft vasculopathy (GV) is the main cause of late death following cardiac transplantation (TX). Early diagnosis of this condition may have an impact upon treatment and prognosis of this complication. Intravascular ultrasound (IVUS) allows an early and accurate diagnosis of GV. However, most centers continue to use coronary angiography for this purpose. Aim: to evaluate coronary angiography for the diagnosis of GV in relation to IVUS in post TX patients. Methods: In a cross-sectional study the results of coronary angiography and IVUS, used as gold standard, were compared in 36 patients with a mean post TX follow up of 3.7 ± 3.7 years. Results were compared between visual and quantitative coronary angiography. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios and the equivalence Spearman-Brown coefficient were calculated. Results: Visual evaluation of coronary angiography was more accurate than quantitative coronary angiography. The sensitivity for GV was 30.4% (95% C.I. 11.6 - 49.2), specificity 92.3% (95% C.I. 77.8 - 106.7), PPV 87.5% (95% C.I. 64.5 - 110.4, NPP 42.8% (95% C.I. 24.5 - 61.1), likelihood ratio (+) 3.9 (95% C.I. 0.55 - 28.7), likelihood ratio (-) 0.75 (95% C.I. 0.55 -1.03). The Spearman Brown coefficient between visual and quantitative coronary angiography evaluation was 0.65. Conclusion: Accuracy and reproducibility of coronary angiography in the evaluation of GV is limited. IVUS should be used for better identification of GV.

Keywords : Cardiac transplantation; Graft vasculopathy; Coronary angiography; Intracoronary ultrasound.

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