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Differences between classic atherosclerosis and transplant vascular disease or cardiac allograft vasculopathy. Note: Reprinted from The American Journal of Cardiology, 78(7), Arbustini E, Roberts WC, Morphologic observations in the epicardial coronary arteries and their surroundings late after cardiac transplantation (allograft vascular disease), 814–820, Copyright 1996, with permission from Elsevier. 76
Source publication
Cardiac allograft vasculopathy (CAV) remains one of the leading causes of death and graft failure after heart transplantation. A variety of causes, including donor heart characteristics, recipient risk factors, and immune-mediated influences, are associated with developing CAV. In this review, we will focus on the pathophysiology of developing CAV...
Context in source publication
Context 1
... This process causes the evolution from focal intimal thickening early after transplant to cir- cumferential diffuse thickening and development of athero- sclerotic plaques at later stages. 23,24 The absolute amount of intimal hyperplasia tends to be constant in the entire arterial tree but is more noticeable in the distal vasculature given the smaller lumen size 25 (Figures 1 and 2). ...
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Citations
... Tako je edina dokončna oblika zdravljenja CAV ponovna presaditev srca. CAV je povezana z visoko stopnjo obolevnosti in umrljivosti prejemnikov ter je vodilni vzrok pozne odpovedi presajenega srca (5,7). Incidenca smrti med prvim in tretjim letom po presaditvi zaradi CAV znaša 10 % ter z vsakim letom narašča (5,7). ...
... CAV je povezana z visoko stopnjo obolevnosti in umrljivosti prejemnikov ter je vodilni vzrok pozne odpovedi presajenega srca (5,7). Incidenca smrti med prvim in tretjim letom po presaditvi zaradi CAV znaša 10 % ter z vsakim letom narašča (5,7). V prvih 5 letih po presaditvi najdemo CAV pri približno 30 % prejemnikov, 10 let po presaditvi srca pa že pri vsakem drugem bolniku s presajenim srcem (5). ...
Omejujoči dejavnik kratkoročnega preživetja pri bolnikih po presaditvi srca je zavrnitev presadka, dolgoročno preživetje pa omejuje predvsem vaskulopatija presadka. Za bolnike po presaditvi srca je ključnega pomena, da morebitno zavrnitveno reakcijo ali pa vaskulopatijo presadka odkrijemo v zgodnji fazi bolezni, ko so terapevtski ukrepi še učinkoviti in presadek še ni nepovratno poškodovan. Danes je prva izbira pri diagnosticiranju vaskulopatije koronarografija, zlati standard pri diagnosticiranju zavrnitvene reakcije pa je endomiokardna biopsija. Zaradi invazivnosti, potrebe po hospitalni obravnavi in suboptimalni občutljivosti obeh preiskav se vse več raziskav usmerja v neinvazivne diagnostične pristope, med katerimi se je kot obetajoča preiskava izkazalo zlasti magnetnoresonančno slikanje srca. V preglednem članku bomo predstavili uporabnost magnetnoresonančnega slikanja srca pri bolnikih s presajenim srcem, njegove prednosti in izhodišča za razvoj pri zgodnjem diagnosticiranju zavrnitvenih reakcij in vaskulopatije presadka v prihodnosti.
Background
Cardiac allograft vasculopathy, the leading cause of graft failure in pediatric heart transplant recipients, is characterized by diffuse and concentric coronary intimal thickening. Early treatment yields better outcomes. While coronary angiography is the standard for cardiac allograft vasculopathy screening and diagnosis, it only identifies luminal narrowing, which occurs in more severe disease. Coronary optical coherence tomography (OCT) is a high-definition intravascular imaging modality that may offer earlier diagnosis. We used OCT to investigate coronary intimal thickening in pediatric transplant recipients and examined its (1) location (ie, vessel type and location) and (2) nature (ie, characteristics of cross-sectional and longitudinal thickening).
Methods
Sites collected coronary angiography and OCT data from participants (N=258 vessel segments from 73 individuals; median age: 11.5 years [8.4–15.3]; 55% male). Images were collected from the left anterior descending, left circumflex, and right coronary arteries, and location (ie, proximal, middle, and distal) were classified using coronary angiography.
Results
OCT identified 32 vessel segments meeting criteria for significant thickening, 88% of which were angiographically silent. Longitudinal thickening was segmental rather than global in 88%, and cross-sectional thickening was 48% eccentric and 52% concentric. Intimal thickening prevalence and severity measures did not consistently differ between coronary artery type ( P =1.000) or location ( P =0.248) but increased with time since transplant and age at transplant and OCT procedure.
Conclusions
In pediatric transplant recipients, we observed a surprisingly high prevalence of segmental and eccentric intimal thickening. Insights from intravascular imaging suggest these patterns of coronary vascular changes may precede overt cardiac allograft vasculopathy. Identifying early changes may offer opportunity for enhanced surveillance and earlier intervention.
