Heart Care Info - Heart Disease Prevention & Treatment

Recent Developments on Coronary Microvasculopathy after Heart Transplantation: A New Target in the Therapy of Cardiac Allograft Vasculopathy

F Tona, M Perazzolo Marra, M Fedrigo... - Current Vascular ..., 2012 - Abstract: Heart transplantation (HTx) is the treatment of choice for patients with refractory end-stage heart diseases. Although the procedure is considered effective in extending and improving quality of life, the onset of cardiac allograft vasculopathy (CAV) continues to ... [CITATION] Orthotopic Heart Transplant Facilitated Autologous Hematopoietic Stem Cell Transplantation in Light-Chain Amyloidosis RT Kamble, G Carrum, L Rice, J Mc Carthy... - Biology of Blood and ..., 2012 - Elsevier

Heart transplantation (H Tx) is the treatment of choice for patients with refractory end-stage heart diseases. Although the procedure is considered effective in extending and improving quality of life, the onset of cardiac allograft vasculopathy (CAV) continues to limit the long-term success of H Tx. Emerging data indicate that the endothelium plays a significant role in the onset, progression and complication of this multifactorial disease, with both immunologic and nonimmunologic risk factors contributing to its development. Improving our understanding of the integral role of the coronary microcirculation in CAV is of crucial clinical interest since it could provide further insights into the related pathophysiological mechanisms and possible new strategies for CAV prevention and therapy. Assessment of coronary microvasculopathy has been shown to be of predictive value after H Tx. Predominant allograft microvascular dysfunction is detectable in 15-20 of patients after H Tx. Very recently, stenotic microvasculopathy (detected in biopsy samples) has been characterized as a prognostic factor for long-term survival after H Tx. The ability to detect and distinguish changes in epicardial and microvascular function may aid in identifying modifiable factors that lead to CAV. Improved immunosuppressive drugs, including mycophenolate mofetil and proliferation signal inhibitors, as well as statins (in part via immunomodulation), may have a beneficial effect on coronary microcirculation after H Tx, although there is still a need to confirm the impact of vasodilators in improving the prognosis of H Tx patients. We review the role of coronary microvasculopathy in H Tx, its prevention and new potential pharmacological interventions.