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Diagnosis and prognosis of cardiac allograft vasculopathy

Author
Finn Gustafsson, MD, PhD
Section Editor
Sharon A Hunt, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Cardiac transplantation is the definitive therapy for eligible patients with end-stage heart failure. The major limitations to survival in the early post-transplant period (first six months) are nonspecific graft failure, acute rejection, and infection [1]. Beyond the first year, cardiac allograft vasculopathy (CAV, also called transplant coronary artery disease or cardiac transplant vasculopathy) is among the top three causes of death. (See "Prognosis after cardiac transplantation", section on 'Causes of death'.)

Ischemic consequences of CAV include graft failure, arrhythmias, and sudden death. CAV may cause myocardial infarction, but because of cardiac denervation, it only rarely causes angina pectoris.

The epidemiology, approach, and outcomes of the diagnosis of transplant vasculopathy will be reviewed here. The pathogenesis, risk factors for, prevention, and treatment of transplant vasculopathy are discussed separately. (See "Pathogenesis of and risk factors for cardiac allograft vasculopathy" and "Prevention and treatment of cardiac allograft vasculopathy".)

DEFINITIONS AND TERMINOLOGY

The prevalence and prognosis of cardiac allograft vasculopathy (CAV) after cardiac transplantation vary considerably depending on how vasculopathy is defined and which method is used to detect it. Some studies have defined CAV as coronary artery stenosis ranging from 30 to 70 percent by coronary angiography. Other studies have diagnosed CAV using the much more sensitive technique of intravascular ultrasound.

To resolve the problem of disparate definitions of CAV, guidelines for terminology related to CAV were published by the International Society for Heart and Lung Transplantation in 2010 [2]. A grading system based on conventional invasive coronary angiographic findings and graft function (evaluated by echocardiography or invasive hemodynamic data) was established (table 1).

                         

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Literature review current through: Nov 2016. | This topic last updated: Thu Feb 11 00:00:00 GMT+00:00 2016.
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