Discordant Microvascular and Epicardial Disease in Cardiac Allograft Vasculopathy
Angiography and intravascular ultrasound (IVUS) of the epicardial coronary vasculature are routinely undertaken for cardiac allograft vasculopathy (CAV) assessment. Microvascular disease is common in CAV and may occur independently of epicardial disease. The purpose of this study was to examine the relationship between microvascular disease, epicardial disease and microvascular dysfunction in heart transplant (HT) patients.
Cardiac allograft vasculopathy (CAV) is a leading cause of death and re-transplantation (tx). Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are increasingly used for earlier detection, but lengthen procedure time and cost, and are unsuitable in small children. Coronary angiography is routine in all age groups but may be subjectively interpreted. We hypothesized that serial analysis of quantitative coronary angiography (QCA) is possible in infants and children and may also predict disease progression.
AbstractBackgroundWe previously demonstrated high diagnostic accuracy of Rubidium-82 positron emission tomography (PET) myocardial blood flow (MBF) quantification for CAV. The purpose of this study was to validate multiparametric PET detection of CAV by combined rate-pressure-product-corrected myocardial flow reserve (cMFR), stress MBF, and coronary vascular resistance (CVR) assessment.Methods and ResultsDiagnostic CAV cut-offs of cMFR
Cardiac allograft vasculopathy (CAV) remains a leading cause of death after heart transplantation (HT). Its detection relies on coronary angiography and assessment of maximal intimal thickness (MIT) by intravascular ultrasound (IVUS). Gene Expression Profile (GEP) testing is a non-invasive way to survey rejection post-HT; however, whether it may help detect chronic rejection in the form of CAV is unknown.
The impact of mild (1R) acute cellular rejection (ACR) on the development of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx) remains unclear. We aimed to investigate the association between mild ACR within 1 year of HTx and development of CAV at 3 years post HTx.
Reduced macrophage cholesterol efflux capacity (CEC) is associated with accelerated early cardiac allograft vasculopathy (CAV) based on intravascular ultrasound (Javaheri et al., JHLT, 2016). However, whether reduced CEC is associated with clinically defined, angiographic CAV and clinical events remains controversial. We tested the hypothesis that reduced pre-transplant CEC is associated with incident, angiographic CAV and mortality in the Clinical Trials in Organ Transplantation 18 (CTOT18) trial.
Although coronary angiography is considered the gold standard and most commonly used test for the surveillance of cardiac transplant recipients, intravascular ultrasound (IVUS) has emerged as a superior screening modality for cardiac allograft vasculopathy (CAV). Owing to cost and complexity, however, only few centers use IVUS routinely.
Increased levels of angiogenic factors are associated with cardiac allograft vasculopathy (CAV). Errant neovascularizations and coronary artery fistulae (CAF) are commonly found on surveillance angiography after transplant and may signify amplified angiogenesis. We sought to explore the relationship between the presence of these angiogenic anomalies and coronary plaque progression as assessed by intravascular ultrasound (IVUS).
Abstract Cardiac allograft vasculopathy is a major cause of morbidity and mortality among patients after heart transplantation. We sought to assess the amount of lipid accumulation in the coronary arteries of transplant patients according to rejection grade. Overall, 39 consecutive heart transplant recipients undergoing annual routine surveillance coronary angiography underwent near-infrared spectroscopy and intravascular ultrasound imaging of 1 coronary artery. Rejection history was graded according to the International Society of Heart and Lung Transplantation (ISHLT) classification as none/mild/moderate-grade ...
Abstract BACKGROUND: Cardiac allograft vasculopathy (CAV) limits long-term success after heart transplant. We assessed the post-transplant risk factors for CAV development.Methods and Results:Patients who underwent heart transplant between May 1999 and December 2013 were included in this study. Patients (n=54) were divided into 2 groups according to the presence or absence of CAV progression after transplant. Coronary angiogram and intravascular ultrasound were conducted within 5-11 weeks after transplant, at 12 months, and annually thereafter. Scheduled endomyocardial biopsies were performed after transplant ...
Cardiac allograft vasculopathy (CAV) remains the major cause of late graft-related death after heart transplantation (HT). Identification of patients at risk of cardiovascular events has relevant implications in appropriately guiding resources and intensity of follow-up. In this context, prognostic relevance of serial coronary imaging long-term after transplant is unexplored.