Graft vasculopathy: comparison of cyclosporine and tacrolimus over 15 + years

versial. We assessed the potential role of noninvasive CFR evaluation as predictor of CAV. Methods: We studied 26 heart transplant (HT) recipients (13 male, aged 46 12 years at HT) without wall motion abnormalities and hypertrophy by transthoracic echocardiography. Coronary blood flow velocity in the left anterior descending coronary artery was noninvasively detected by contrast-enhanced transthoracic echocardiography (CE-TTE) at 7 5.5 years after HT. CFR was calculated by the ratio of averaged peak systolic-diastolic flow velocity (APV) during adenosine infusion to baseline APV. CE-TTE assessment of CFR was achieved before each of the 26 angiographic studies. A CFR 2 was regarded as normal. Comparison of means was made by Student’s t test. A p value 0.05 was considered to be significant. Results: CAV was diagnosed in 12 out of 26 patients (pts) (46%) (group A) while 14 pts had normal coronary angiograms (group B). Septal and posterior left ventricular wall thickness were similar in the two groups (9.6 0.9 vs 9.8 1.16 mm; 8.9 0.6 vs 9.4 0.8 mm respectively, p NS). Blood haemoglobin, heart rate, systolic and diastolic blood pressure were also similar. CFR was 2.7 0.7 in all pts and reduced in group A vs group B (2.19 0.46 vs 3.13 0.64, p 0.0001). Conclusions: Our data suggest that impaired CFR by CE-TTE is associated with angiographically detectable CAV. CFR impairment seems related to dysfunction of the coronary microcirculation rather than enhanced myocardial oxygen consumption. CE-TTE may represent a promising noninvasive diagnostic tool in CAV.