Cardiac allograft vasculopathy
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC
Cardiac allograft vasculopathy | |
---|---|
![]() | |
Synonyms | CAV |
Pronounce | N/A |
Specialty | Cardiology |
Symptoms | Angina, heart failure, arrhythmia |
Complications | Heart transplant failure, myocardial infarction |
Onset | Months to years after heart transplant |
Duration | Chronic |
Types | N/A |
Causes | Immune-mediated injury, chronic rejection |
Risks | Hyperlipidemia, hypertension, diabetes mellitus, cytomegalovirus infection |
Diagnosis | Coronary angiography, intravascular ultrasound |
Differential diagnosis | Coronary artery disease |
Prevention | Statins, immunosuppressive therapy |
Treatment | Percutaneous coronary intervention, retransplantation |
Medication | N/A |
Prognosis | Variable, often poor without intervention |
Frequency | Common in long-term heart transplant recipients |
Deaths | N/A |
File:Primary-Angioplasty-for-Cardiac-Allograft-Vasculopathy-Presenting-as-ST-Elevation-Acute-Myocardial-606481.f1.ogv Cardiac Allograft Vasculopathy (CAV) is a complex and multifactorial disease process that affects the coronary arteries of heart transplant recipients. It is characterized by diffuse coronary artery narrowing caused by intimal thickening, which can lead to ischemic heart disease, graft failure, and death. CAV is a significant cause of morbidity and mortality in the post-transplant period, and its management requires a multidisciplinary approach.
Etiology and Pathogenesis
The exact cause of CAV is not fully understood, but it is believed to be the result of both immune and non-immune factors. Immune factors include acute and chronic rejection episodes, while non-immune factors encompass traditional cardiovascular risk factors, such as hypertension, hyperlipidemia, diabetes, and smoking, as well as specific transplant-related factors like cytomegalovirus (CMV) infection and the use of calcineurin inhibitors. The pathogenesis of CAV involves endothelial injury and dysfunction, leading to an inflammatory response, smooth muscle cell proliferation, and extracellular matrix deposition. This process results in intimal thickening and narrowing of the coronary arteries, which impairs myocardial perfusion.
Clinical Presentation
CAV can be asymptomatic in its early stages due to the denervated status of the transplanted heart, which can mask typical angina symptoms. As the disease progresses, patients may present with heart failure symptoms, arrhythmias, or sudden cardiac death. Given the insidious onset and progression of CAV, regular monitoring through coronary angiography or other imaging modalities is critical for early detection.
Diagnosis
The diagnosis of CAV is primarily based on coronary angiography, which can reveal diffuse coronary artery narrowing. Intravascular ultrasound (IVUS) is a more sensitive tool that can detect early intimal thickening before angiographic changes become apparent. Other non-invasive imaging techniques, such as cardiac computed tomography (CT) angiography and magnetic resonance imaging (MRI), are also useful in assessing coronary artery anatomy and myocardial perfusion.
Treatment
The management of CAV focuses on the modification of risk factors, immunosuppressive therapy adjustment, and revascularization procedures. Statins are used for their lipid-lowering effects and potential immunomodulatory properties. Optimization of immunosuppression may involve increasing the doses of existing drugs or switching to alternative agents. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered for significant stenoses, although their efficacy is limited by the diffuse nature of the disease. In advanced cases, retransplantation may be the only option.
Prevention
Preventive strategies for CAV include aggressive management of cardiovascular risk factors, careful selection of immunosuppressive regimens, and monitoring for and treatment of CMV infection. Early detection through regular imaging surveillance is also crucial for the timely initiation of treatment.
Prognosis
The prognosis of patients with CAV is poorer than those without the disease, with increased risks of graft loss and death. The severity of coronary artery narrowing and the presence of cardiac allograft dysfunction are important prognostic indicators.
This article is a cardiovascular system stub. You can help WikiMD by expanding it!
This article is a transplant stub. You can help WikiMD by expanding it!
Transform your life with W8MD's budget GLP-1 injections from $125.
W8MD offers a medical weight loss program to lose weight in Philadelphia. Our physician-supervised medical weight loss provides:
- Most insurances accepted or discounted self-pay rates. We will obtain insurance prior authorizations if needed.
- Generic GLP1 weight loss injections from $125 for the starting dose.
- Also offer prescription weight loss medications including Phentermine, Qsymia, Diethylpropion, Contrave etc.
NYC weight loss doctor appointments
Start your NYC weight loss journey today at our NYC medical weight loss and Philadelphia medical weight loss clinics.
- Call 718-946-5500 to lose weight in NYC or for medical weight loss in Philadelphia 215-676-2334.
- Tags:NYC medical weight loss, Philadelphia lose weight Zepbound NYC, Budget GLP1 weight loss injections, Wegovy Philadelphia, Wegovy NYC, Philadelphia medical weight loss, Brookly weight loss and Wegovy NYC
WikiMD's Wellness Encyclopedia |
Let Food Be Thy Medicine Medicine Thy Food - Hippocrates |
Medical Disclaimer: WikiMD is not a substitute for professional medical advice. The information on WikiMD is provided as an information resource only, may be incorrect, outdated or misleading, and is not to be used or relied on for any diagnostic or treatment purposes. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. WikiMD expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site. By visiting this site you agree to the foregoing terms and conditions, which may from time to time be changed or supplemented by WikiMD. If you do not agree to the foregoing terms and conditions, you should not enter or use this site. See full disclaimer.
Credits:Most images are courtesy of Wikimedia commons, and templates, categories Wikipedia, licensed under CC BY SA or similar.
Contributors: Prab R. Tumpati, MD