2014
DOI: 10.5500/wjt.v4.i2.93
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Coronary microvasculopathy in heart transplantation: Consequences and therapeutic implications

Abstract: Despite the progress made in the prevention and treatment of rejection of the transplanted heart, cardiac allograft vasculopathy (CAV) remains the main cause of death in late survival transplanted patients. CAV consists of a progressive diffuse intimal hyperplasia and the proliferation of vascular smooth muscle cells, ending in wall thickening of epicardial vessels, intramyocardial arteries (50-20 μm), arterioles (20-10 μm), and capillaries (< 10 μm). The etiology of CAV remains unclear; both immunologic and n… Show more

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Cited by 29 publications
(21 citation statements)
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“…Fibroblasts represent a potential reservoir of particular interest, since virus produced in fibroblasts can infect many cell types, whereas virus produced in endothelial cells shows a strong tropism for that cell type (63). Likewise, ubiquitous smooth muscle cells represent a potential site for infection leading to vascular inflammation, which is a risk factor for heart transplant patients (83). The infection of both of these cells has been documented in the blood vessels of floating villi and the chorions of congenitally infected placentas (84).…”
Section: Discussionmentioning
confidence: 99%
“…Fibroblasts represent a potential reservoir of particular interest, since virus produced in fibroblasts can infect many cell types, whereas virus produced in endothelial cells shows a strong tropism for that cell type (63). Likewise, ubiquitous smooth muscle cells represent a potential site for infection leading to vascular inflammation, which is a risk factor for heart transplant patients (83). The infection of both of these cells has been documented in the blood vessels of floating villi and the chorions of congenitally infected placentas (84).…”
Section: Discussionmentioning
confidence: 99%
“…The immune and inflammatory mediated endothelial injury also leads to endothelial function [10]. Using serial studies with Doppler flow-wire measurements, decrements in coronary endothelial function have been demonstrated to be associated with progressive intimal thickening and subsequent CAV development [11].…”
Section: Risk Factors and Pathophysiology Of Cavmentioning
confidence: 99%
“…The International Society for Heart and Lung Transplantation guidelines suggest measuring CFR invasively during coronary angiography as an option for detecting microvascular disease in cardiac transplant recipients in whom CAV is suspected. 3,19 However, CFR is not a specific parameter for microvascular dysfunction because it interrogates the entire coronary circulation, both the epicardial vessel and the microvasculature, and therefore is affected by epicardial artery stenosis. Moreover, because CFR is defined in part by resting flow, it is influenced by changes in resting hemodynamic conditions such as blood pressure, heart rate, and ventricular contractility.…”
Section: Importance Of Microvascular Dysfunctionmentioning
confidence: 99%
“…1,2 The characteristic of CAV is diffuse intimal proliferation involving both the epicardial artery and the microvasculature. 3,4 Coronary angiography lacks the resolution to diagnose early stages of CAV. 5 Intravascular ultrasound (IVUS) has greater resolution and has been shown to detect changes in epicardial CAV predictive of late adverse outcome after cardiac transplantation.…”
mentioning
confidence: 99%