International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy—2010

Mehra, Mandeep R.; Crespo‐Leiro, María G.; Dipchand, Anne I.; Ensminger, Stephan; Hiemann, N.E.; Kobashigawa, Jon A.; Madsen, Joren C.; Parameshwar, Jayan; Starling, Randall C.; Uber, Patricia A.

doi:10.1016/j.healun.2010.05.017

Cited by 764 publications

(600 citation statements)

References 83 publications

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“…In the Rejection Group, most patients presented with rejection grade 1B; there were only 7 patients in rejection grade 2 and one in 3A and one in 3B. Coronary angiography performed one month after heart transplantation revealed mild cardiac allograft vasculopathy 15 in three patients, all of whom were in the rejection group. The rest of the patients were free from cardiac allograft vasculopathy.…”

Section: Clinical Datamentioning

confidence: 93%

“…All consecutive heart transplant patients referred to our center for routine EMB between August 2008 and September 2010 were eligible for recruitment to this study. Exclusion criteria were: 1) LV EF <55%; 2) moderate or higher grade valvular pathology; 3) clinically significant pericardial effusion; 4) inadequate acoustic window; 5) moderate or higher grade cardiac allograft vasculopathy 15 assessed by routine coronary angiography (performed one month and one year after the heart transplantation); 6) unwillingness of the patient to participate in this study; 7) unavailability of study personnel.…”

Section: Study Populationmentioning

confidence: 99%

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Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Podroužková¹,

Bedáňová²,

Třetina³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Around 20-40% of heart transplant patients experience moderate to severe rejection within the first year after heart transplantation. Endomyocardial biopsy (EMB) is a gold standard for diagnosing heart transplant rejection. There is a need for non-invasive alternatives that allow for early, safe and reliable diagnosis of acute graft rejection prior to the onset of clinical symptoms. Aims. Our aim was to investigate the potential of speckle tracking derived strain analysis in the diagnosis of acute graft rejection. Methods. Patients indicated for EMB consented to a trans-thoracic echocardiography examination (TTE) within 2 hours of the EMB. Of this cohort, those with at least 2 EMBs separated ≥ 1 week, and whose TTE could be analyzed for strain, were included. The relationship between strain and EMB results was evaluated. Results. Of the 43 patients included (mean age 51.33±1.79, 67% male), 23 had findings of rejection identified on at least one EMB and at least one EMB without rejection for comparison. A significant deterioration in the longitudinal strain during rejection compared to non-rejection was found on apical 4-chamber views (-11.51±0.91 vs -13.48±0.96, P=0.025) and apical 2-chamber views (-11.84±0.78 vs -14.43±0.83, P=0.002). In the patients in whom no rejection was identified on either EBM, there was no significant change in longitudinal strain values at two different time points. Conclusion. Worsening of longitudinal strain was associated with acute cellular rejection. Routine TTE-based strain analysis could help in early detection of cardiac rejection and timing of EMB.

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Section: Clinical Datamentioning

confidence: 93%

Section: Study Populationmentioning

confidence: 99%

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Podroužková¹,

Bedáňová²,

Třetina³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…There was no uniform definition or description until International Society of Heart and Lung Transplant (ISHLT) formulated the definition and nomenclature for CAV ( Table 1). ISHLT issued a consensus statement in 2010 stating that coronary angiography in conjunction with assessment of cardiac allograft function is likely to detect CAV with high degree of confidence [20]. Despite pathological differences, CAV and traditional coronary artery disease (CAD) do share some similarities and have some common contributing factors (Table 2) [10,[21][22][23].…”

Section: Definition and Diagnosismentioning

confidence: 99%

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Munagala¹,

Phancao²

2018

obm.transplant

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Heart transplant remains the gold standard therapy for patients with end stage heart disease and offers improved survival and quality of life. Significant progress has been achieved in improving one-year mortality after heart transplantation. Nonetheless, longterm graft survival has not changed significantly over the past few decades. Long term survival of heart transplant recipients is limited by chronic rejection, cardiac allograft vasculopathy (CAV), and malignancy. CAV is a major contributor for graft failure and mortality after the first year of in heart transplant recipients. CAV is a proliferative vasculopathy characterized by diffuse myointimal hyperplasia and progressive narrowing of the graft vessels. Both immune dependent and independent factors have been shown to contribute to the pathogenesis of CAV. Understanding these risk factors is essential in developing preventative and therapeutic strategies. Angiography with Intravascular ultrasound has become the key diagnostic tool in the early detection of CAV as well as prognostication. Echocardiographic assessment of allograft function in conjunction with coronary angiographic findings are used in assessing the severity of CAV. Adjustment of immunosuppression and statins remain the initial steps in the management of CAV. Retransplantation is the definitive treatment for severe CAV, however, the paucity of organs along with increased mortality associated with retransplantation makes it a less desirable option. Remarkable progress has been achieved in the understanding of pathogenesis, risk factors for CAV and plaque morphology. Nevertheless, significant knowledge gaps persist in scientific understanding of risk factors, pathogenesis, prevention and treatment of CAV. Further research is warranted to fill these gaps, develop diagnostic modalities to facilitate early detection of CAV, and management strategies to Improve graft tolerance and immune modulation. This review focuses on summarizing the pathogenesis and risk factors for CAV.

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“…4) Therefore, an International Society for Heart and Lung Transplantation (ISHLT) working group recommended regular surveys with coronary angiography regardless of the recipient's symptoms for early detection of CAV, accompanied by subsequent IVUS when CAV is suspected. 5) Recently, optical coherence tomography (OCT) has emerged as a new generation catheter-based modality that acquires images at a spatial resolution of 10-20 µm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. 6) However, little is known about adaptation of OCT for analyses of CAV.…”

mentioning

confidence: 99%

Cardiac Allograft Vasculopathy Can Be Distinguished From Donor-Transmitted Coronary Atherosclerosis by Optical Coherence Tomography Imaging in a Heart Transplantation Recipient

et al. 2014

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SummaryAlthough survival after heart transplantation (HTx) has improved in recent years, cardiac allograft vasculopathy (CAV) is still the leading cause of remote morbidity and mortality in HTx recipients, partly because of diffi culty with its diagnosis. In general, routine surveillance for CAV is advocated with coronary angiography accompanied by intravascular ultrasound (IVUS) if necessary. However, these modalities have limitations with respect to low spatial resolution, and suffi cient qualitative/quantitative assessment of coronary intima has not been accomplished. Recently, optical coherence tomography (OCT) has emerged as a novel intracoronary imaging technique using an optical analogue of ultrasound with a spatial resolution of 10-20 µm, which is 10 times greater than IVUS. We here experienced a 49-year-old male who received a HTx 3 years ago, and OCT was executed during low molecular weight dextran injection. OCT demonstrated distinct double intimal layers probably consisting of a donor-transmitted atherosclerotic layer and an inner intimal proliferation due to CAV, which was indistinguishable by IVUS and virtual histological analyses. We believe that OCT imaging is not only a new loadstar during treatment of CAV but also a new generation modality for screening for early CAV in HTx recipients. (Int Heart J 2014; 55: 178-180)

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International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy—2010

Cited by 764 publications

References 83 publications

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Decrease in longitudinal strain in heart transplant recipients is associated with rejection

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Cardiac Allograft Vasculopathy Can Be Distinguished From Donor-Transmitted Coronary Atherosclerosis by Optical Coherence Tomography Imaging in a Heart Transplantation Recipient

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