Cardiac Allograft Vasculopathy: Pathogenesis and Role of Coronary Computed Tomography Angiography in the Diagnosis and Surveillance
Cardiac allograft vasculopathy (CAV) is an entity unique to the cardiac transplant patients and remainsÂ 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 distalÂ vessels and ultimately extending to intramyocardial and epicardial vessels of the allograft. MultipleÂ 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, donorâ€™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 ofÂ angina are usually lacking because of denervated nature of the allograft and it is identified when theÂ graft is already compromised. Currently, invasive testing stands as the gold standard for its diagnosis;Â however its utility has been questioned. Coronary CT angiography (CCTA) has emerged as a promisingÂ noninvasive tool for the diagnosis of CAV. This review discusses the risk factors, pathogenesis andÂ diagnosis of CAV and utility of CCTA in its diagnosis and surveillance.
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