Cardiac Allograft Vasculopathy (CAV)
This infographic explores cardiac allograft vasculopathy (CAV), a significant complication following heart transplantation. It provides key insights into the pathophysiology, diagnosis, and management of CAV, emphasizing the importance of surveillance in transplant recipients.
What is cardiac allograft vasculopathy?
- CAV is characterized by the proliferation of vascular smooth muscle cells and concentric luminal narrowing of coronary arteries and microvasculature within the transplanted heart. Unlike typical atherosclerosis, CAV affects both large epicardial vessels and microvessels. It becomes a common cause of graft dysfunction, occurring in over 30% of patients within five years post-transplant.
Why does cardiac allograft vasculopathy occur?
- CAV has both immunologic and non-immunologic contributors, with immunologic factors playing a larger role. Cellular rejection episodes in the donor heart correlate with the development of CAV. Other factors include HLA mismatch and antibody-mediated rejection. Non-immunologic causes involve donor age, CMV infection, and hyperlipidemia.
How do patients with cardiac allograft vasculopathy present?
- Because the donor heart is denervated, transplant patients may not develop typical angina symptoms. As a result, routine surveillance is critical. Without timely diagnosis, CAV can lead to LV dysfunction, myocardial infarction, arrhythmias, heart block, or sudden cardiac death.
How do we diagnose cardiac allograft vasculopathy?
- Coronary angiography is the primary diagnostic tool, though it has limitations due to the diffuse nature of CAV. Intravascular ultrasound (IVUS) offers greater sensitivity and allows for earlier detection. Timing and method of screening need to be individualized to the patient.
How do we treat cardiac allograft vasculopathy?
- Primary prevention with statins has been shown to reduce CAV incidence and improve survival. Chronic immunosuppression, using mTOR inhibitors like everolimus or sirolimus, also plays a crucial role. In cases of advanced CAV, revascularization may be considered, although it does not improve survival outcomes. Routine follow-up is essential for optimal management.
Produced by Dr. Karan Desai
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