219: Widespread fibrosis of myocardial and adjacent tissues causing restrictive cardiac physiology in patients needing re-do heart transplant

International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy—2010

“…Patients with restrictive cardiac physiology, defined as symptomatic heart failure with an echocardiographic E/A velocity ratio Ͼ 2, shortened isovolumetric relaxation time (Ͻ 60 msec), shortened deceleration time (Ͻ 150 msec), or restrictive hemodynamic values (right atrium Ͼ 12 mm Hg, pulmonary capillary wedge pressure Ͼ 25 mm Hg, cardiac index, Ͻ 2 liters/m 2 ) have a lower 5-year survival than heart transplant patients without restrictive cardiac physiology. 10 It should be noted, however, that restrictive physiology is not specific for the presence of CAV, and thus, its presence should not automatically infer the presence of significant epicardial or small-branch CAV.…”

Diastolic function in heart transplant: From physiology to echocardiographic assessment and prognosis

“…Evidence suggests that the key histopathologic finding in CAV-related diastolic dysfunction is increased capillary wall thickness and reduced capillary density, rather than interstitial fibrosis, which has similar extent in severe CAV and non-significant CAV patients ( 7 , 51 ). Furthermore, the restrictive physiology carries a prognostic significance in CAV patients, as it has been related to a lower 5-year survival ( 52 ).…”

Cardiac Allograft Vasculopathy: An Ongoing Challenge in the Care of Heart Transplant Recipients

“…Patients with CAV and LV dysfunction have significantly lower 5-year survival compared with CAV patients without LV dysfunction (60% vs. 90%) (Stork et al, 2006). Patients with restrictive cardiac physiology [E to A velocity ratio >2, shortened isovolumetric relaxation time (<60msec), shortened deceleration time (≤150ms), or restrictive hemodynamics (right atrial pressure >12mmHg, pulmonary capillary wedge pressure >25mmHg, cardiac index <2.0)] in the presence of preserved LV systolic function and CAV also have a lower 5-year survival than heart transplant patients without restrictive physiology (Itagaki et al, 2007).…”