cardiac allograft vasculopathy

Etiology

• complication of cardiac transplantation

Epidemiology

• occurs in > 50% of patients within 5 years

Pathology

• represents diffuse intimal hyperplasia rather than focal coronary artery stenosis

Clinical manifestations

• uncommon to present as chest pain because of lack of cardiac innervation
• syncope
• new heart failure symptoms
• dyspnea on exertion
• heart block

Diagnostic procedures

• routine ECG to assess
  • silent ischemia/infarction
  • heart block
• dobutamine echocardiography generally unreliable

Radiology

• coronary angiography is generally method of choice
• intracoronary vascular ultrasonography may be better than angiography

Complications

• post-transplant coronary artery disease (CAD) is the primary cause of death >1 year after transplant
• most common cause of heart failure in cardiac transplant patients

Management

• percutaneous coronary intervention may be considered but does not address the diffuse nature of the vasculopathy
• retransplantation is only treatment for multivessel disease

More general terms

• vascular disease (vasculopathy)
• heart disease (cardiac disease)