Cardiac allograft vasculopathy: diagnosis, therapy, and prognosis

Abstract

Development of cardiac allograft vasculopathy represents the major determinant of long-term survival in patients after heart transplantation. Due to graft denervation, these patients seldom present with classic symptoms of angina pectoris, and the first clinical presentations are progressive heart failure or sudden cardiac death. Although coronary angiography remains the routine technique for coronary artery disease detection, it is not sensitive enough for screening purposes. This is especially the case in the first year after transplantation when diffuse and concentric vascular changes can be easily detected only by intravascular ultrasound. The treatment of the established vasculopathy is disappointing, so the primary effort should be directed toward early prevention and diagnosis. Due to diffuse vascular changes, revascularization procedures are restricted only to a relatively small proportion of patients with favorable coronary anatomy. Percutaneous coronary intervention is preferred over surgical revascularization since it leads to better acute results and patient survival. Although there is no proven long-term advantage of drug-eluting stents for the treatment of in-stent restenosis, they are preferred over bare-metal stents. Severe vasculopathy has a poor prognosis and the only definitive treatment is retransplantation. This article reviews the present knowledge on the pathogenesis, diagnosis, treatment, and prognosis of cardiac allograft vasculopathy.

Diagnostic accuracy of dobutamine stress echocardiography in the detection of cardiac allograft vasculopathy in heart transplant recipients: A systematic review and meta‐analysis study

“…Cardiac allograft vasculopathy is a difficult disease to diagnose, and regular surveillance is fundamental for early detection. The earlier it is detected, the better the outcomes for these patients . Invasive modalities such as CA and IVUS are most commonly used to detect CAV .…”

“…The earlier it is detected, the better the outcomes for these patients. 36 Invasive modalities such as CA and IVUS are most commonly used to detect CAV. 5,6 However, the risks associated with cardiac catheterization including high cost, risk of radiation, and contrast exposure mandate the need for a noninvasive imaging alternative.…”

Waskulopatia w przeszczepionym sercu — nowe trendy w diagnostyce i leczeniu

“…U pacjentów po przeszczepieniu z powodu odnerwienia serca nie obserwuje się typowych dolegliwości stenokardialnych, a ich pojawienie się sugeruje zaawansowanie procesu chorobowego [12]. Pierwszymi objawami częściej występującymi niż w przypadku klasycznej miażdżycy tęt-nic wieńcowych są objawy niewydolności serca, zaburzenia rytmu lub nagły zgon sercowy [13].…”

“…Pozwala na zaobserwowanie dwufazowości CAV, polegającej na początkowym pogrubieniu błony wewnętrznej, z zachowaniem światła naczynia oraz zmianach o charakterze zwężenia, do których dochodzi w późniejszym rozwoju choroby [16]. Wykonanie IVUS 4-6 tygodni oraz rok po Htx pozwala wykryć chorobę wieńcową przekazaną od dawcy, wczesne zmiany w naczyniach, a także może dostarczyć informacji prognostycznych [12]. W badaniu wieloośrodkowym z zastosowaniem IVUS wykazano, że [18].…”

Erythroblast transformation-specific 2 correlates with vascular smooth muscle cell apoptosis in rat heterotopic heart transplantation model

“…Shortterm survival has improved significantly with better immunosuppressive therapy and improved surgical techniques. However, recent findings have also revealed that the major determinants of patient long-term survival are malignancy and cardiac allograft vasculopathy (CAV), which is also known as transplant coronary artery disease or cardiac transplant vasculopathy (6,7). Multiple experimental and clinical studies have shown that vascular smooth muscle cell (VSMC), especially its migration, proliferation and apoptosis (8)(9)(10), plays an important role in the formation of CAV.…”