Cardiac allograft vasculopathy coronary angiography

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Early diagnosis of CAV is of utmost importance as it allows alterations to optimal immunosuppression and risk factor modification prolonging graft survival and reducing morbidity and mortality. In most transplant centers coronary angiography is currently used to screen and diagnose transplant associated coronary artery disease.

Coronary Angiography

Previously, the diagnosis of CAV was made pathologically. However, with the advent of calcineurin-based immunosuppression post-cardiac transplant survival improved significantly and angiographic diagnosis became a standard. Currently, the International Society for Heart and Lung Transplantation (ISHLT) recommends annual invasive coronary angiography as the standard imaging technique to screen for CAV.[1] Angiographic evidence of coronary artery disease is very common after heart transplantation. In a multiinstitutional study by Constanzo et al it was demonstrated that by the end of 5 years after transplantation 42% of heart transplant subjects had angiographic evidence of graft coronary artery disease.[2]

References

  1. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S; et al. (2010). "The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients". J Heart Lung Transplant. 29 (8): 914–56. doi:10.1016/j.healun.2010.05.034. PMID 20643330.
  2. Costanzo MR, Naftel DC, Pritzker MR, Heilman JK, Boehmer JP, Brozena SC; et al. (1998). "Heart transplant coronary artery disease detected by coronary angiography: a multiinstitutional study of preoperative donor and recipient risk factors. Cardiac Transplant Research Database". J Heart Lung Transplant. 17 (8): 744–53. PMID 9730422.

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