Cardiac Allograft Vasculopathy: Pathogenesis and Role of Coronary Computed Tomography Angiography in the Diagnosis and Surveillance

Nidhi Madan, Panagiota Christia, Robert T. Faillace

Abstract


Cardiac allograft vasculopathy (CAV) is an entity unique to the cardiac transplant patients and remains the leading cause of mortality after the first year of transplantation causing chronic allograft rejection. It is an accelerated form of coronary artery disease, occurring diffusely, starting from the small distal vessels and ultimately extending to intramyocardial and epicardial vessels of the allograft. Multiple traditional metabolic risk factors known to cause atherosclerosis have been identified as a trigger for CAV. Moreover, several nontraditional environmental risk factors such as viral infections, donor’s age, underlying cardiac disease and mechanism of donor brain death have also been implicated. The pathogenesis of CAV is complex with involvement of both immunological and non-immunological mechanisms and still remains poorly understood. Clinical diagnosis of CAV is difficult as symptoms of angina are usually lacking because of denervated nature of the allograft and it is identified when the graft is already compromised. Currently, invasive testing stands as the gold standard for its diagnosis; however its utility has been questioned. Coronary CT angiography (CCTA) has emerged as a promising noninvasive tool for the diagnosis of CAV. This review discusses the risk factors, pathogenesis and diagnosis of CAV and utility of CCTA in its diagnosis and surveillance.


Keywords


Cardiac allograft vasculopathy, coronary computed tomography angiography, cardiac transplant.

Full Text:

PDF

Refbacks

  • There are currently no refbacks.