Stress Echocardiography After Cardiac Transplantation

Abstract

Cardiac transplantation is an increasingly important treatment for end-stage cardiac disease, but rejection continues to be a major complication. Rejection can be either acute or chronic [1] (Table 1). Acute rejection is a major problem in the istyear following cardiac transplantation [1]. It is characterized by normal epicardial coronary arteries, with a concomitant restriction in coronary flow reserve [2] — a pathophysiological hallmark of microvascular disease, as it has been described in other situations such as syndrome X or hypertension with normal coronary arteries (Chap. 19). In particular, during acute cardiac rejection, the reversible reduction of coronary reserve could be the result of the limitation of vasodilation due to functional abnormalities such as metabolically or immunologically related decreased responsiveness of vascular wall to vasodilator stimuli or to structural abnormalities, for example, interstitial edema or cellular infiltration [2].