Cardiac allograft vasculopathy natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
* CAV is a slowly progressive disease of the graft vessels. However it may progress rapidly in some post-transplant patients. For example, about 7% of patients from the Cardiac Transplant Research Database had severe disease that progressed rapidly by the end of 5 years. | * CAV is a slowly progressive disease of the graft vessels. However it may progress rapidly in some post-transplant patients. For example, about 7% of patients from the Cardiac Transplant Research Database had severe disease that progressed rapidly by the end of 5 years. | ||
* In a few years post-transplant, the disease progresses from clean coronary vasculature to diffusely diseased, obstructive pattern. | * In a few years post-transplant, the disease progresses from clean coronary vasculature to diffusely diseased, obstructive pattern. | ||
* A 5 year prospective study by Tsutsui and colleagues using [[intravascular usltrasound]] ([[IVUS]]) revealed that most of the intimal thickening in CAV develops during the first year after heart transplantation <ref name="pmid11489770">{{cite journal| author=Tsutsui H, Ziada KM, Schoenhagen P, Iyisoy A, Magyar WA, Crowe TD et al.| title=Lumen loss in transplant coronary artery disease is a biphasic process involving early intimal thickening and late constrictive remodeling: results from a 5-year serial intravascular ultrasound study. | journal=Circulation | year= 2001 | volume= 104 | issue= 6 | pages= 653-7 | pmid=11489770 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11489770 }} </ref>. | |||
* Late onset of CAV is infrequent. The process of development of CAV is rather slow in those who develop CAV 10 years post-transplant. | * Late onset of CAV is infrequent. The process of development of CAV is rather slow in those who develop CAV 10 years post-transplant. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
Natural History
- CAV is a slowly progressive disease of the graft vessels. However it may progress rapidly in some post-transplant patients. For example, about 7% of patients from the Cardiac Transplant Research Database had severe disease that progressed rapidly by the end of 5 years.
- In a few years post-transplant, the disease progresses from clean coronary vasculature to diffusely diseased, obstructive pattern.
- A 5 year prospective study by Tsutsui and colleagues using intravascular usltrasound (IVUS) revealed that most of the intimal thickening in CAV develops during the first year after heart transplantation [1].
- Late onset of CAV is infrequent. The process of development of CAV is rather slow in those who develop CAV 10 years post-transplant.
Complications
Most of the complications of CAV are related to myocardial hypoperfusion. These include:
- Graft failure
- Myocardial infarction
- Sudden death
- Congestive heart failure (sometimes in the form of rapidly developing systolic failure)
- Arrhythmias
Prognosis
- All-cause mortality data from 1982 up to June 2011 shows 1 year survival of 81% and 5 year survival of 69%, with median survival of 10 years for all and 13 years for those surviving until the end of first year. The most recent cohort of patients show unadjusted 1 year survival of 84%.
- The survival curve demonstrates a steep fall in survival in the first 6 months post-transplant. Thereafter, it steadily decreases by 3.5% per year and continues to do so well beyond 15 years. Presence of CAV is the strongest predictor of mortality in patients who survive beyond 1 year post-transplant.
- The ISHLT Registry showed that CAV together with late graft failure was responsible for about 33% of deaths 5 years post-transplant.
- Also the survival of patients with CAV has in fact improved over the last decade.
References
- ↑ Tsutsui H, Ziada KM, Schoenhagen P, Iyisoy A, Magyar WA, Crowe TD; et al. (2001). "Lumen loss in transplant coronary artery disease is a biphasic process involving early intimal thickening and late constrictive remodeling: results from a 5-year serial intravascular ultrasound study". Circulation. 104 (6): 653–7. PMID 11489770.