Cardiac allograft vasculopathy coronary angiography
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Cardiac allograft vasculopathy Microchapters |
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Differentiating Cardiac allograft vasculopathy from other Diseases |
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Cardiac allograft vasculopathy coronary angiography On the Web |
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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 cardiac allograft vasculopathy (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]
Advantages
- Wide acceptability
- Reduced healthcare cost compared with other novel intracoronary imaging techniques
- Ease of performance
Limitations
- Lower sensitivity compared with histopathological studies, intravascular ultrasound (IVUS) and optical coherence tomography (OCT), especially in detecting early-stage CAV
- Risk of contrast nephropathy in heart transplant subjects in whom chronic renal failure is a usual comorbidity
References
- ↑ 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.
- ↑ 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.