Cardiac allograft vasculopathy: A review.

Published

Journal Article

Cardiac allograft vasculopathy (CAV) is a complex disease that remains a significant cause of morbidity and mortality after orthotopic heart transplantation (OHT). Originating as a result of inflammatory response, the development and progression of CAV is attributed to endothelial dysfunction, cellular infiltration, and a wide-range of genetic and patient factors. The detection of CAV remains a diagnostic challenge, as symptoms can be variable or absent. While coronary angiography remains the initial test of choice for the diagnosis and surveillance of CAV, intravascular imaging (either by ultrasound or optical coherence tomography) and physiologic assessments are useful adjuncts in the cardiac catheterization laboratory. Positron emission tomography, computed tomographic, and magnetic resonance imaging may have a role increasing the time interval between invasive screening tests for prognosis. Medical management should include a statin, vasodilator, and tailored immunosuppressive regimen that maximally decrease allograft rejection and CAV progression while causing minimal side effects. Patients that are less responsive to pharmacotherapy should be considered for invasive management with percutaneous coronary intervention. Although surgical revascularization is a poor option, repeat OHT is the only definitive treatment option but given its morbidity should be reserved for a highly selected patient population.

Full Text

Duke Authors

Cited Authors

  • Lee, MS; Tadwalkar, RV; Fearon, WF; Kirtane, AJ; Patel, AJ; Patel, CB; Ali, Z; Rao, SV

Published Date

  • December 2018

Published In

Volume / Issue

  • 92 / 7

Start / End Page

  • E527 - E536

PubMed ID

  • 30265435

Pubmed Central ID

  • 30265435

Electronic International Standard Serial Number (EISSN)

  • 1522-726X

International Standard Serial Number (ISSN)

  • 1522-1946

Digital Object Identifier (DOI)

  • 10.1002/ccd.27893

Language

  • eng