Izvorni znanstveni članak
https://doi.org/10.3325/cmj.2014.55.562
Cardiac allograft vasculopathy: diagnosis, therapy, and prognosis
Boško Skorić
orcid.org/0000-0001-5979-2346
; Department of Cardiovascular Diseases, University Hospital CenterZagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Maja Čikeš
; Department of Cardiovascular Diseases, University Hospital CenterZagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Jana Ljubas Maček
; Department of Cardiovascular Diseases, University Hospital CenterZagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Željko Baričević
; Department of Cardiovascular Diseases, University Hospital CenterZagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Ivan Škorak
; Department of Cardiovascular Diseases, University Hospital CenterZagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Hrvoje Gašparović
; Department of Cardiac Surgery,University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
Bojan Biočina
; Department of Cardiac Surgery,University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
Davor Miličić
; Department of Cardiovascular Diseases, University Hospital CenterZagreb, University of Zagreb School of Medicine, Zagreb, Croatia
Sažetak
Development of cardiac allograft vasculopathy represents
the major determinant of long-term survival in patients after
heart transplantation. Due to graft denervation, these
patients seldom present with classic symptoms of angina
pectoris, and the first clinical presentations are progressive
heart failure or sudden cardiac death. Although coronary
angiography remains the routine technique for coronary
artery disease detection, it is not sensitive enough for
screening purposes. This is especially the case in the first
year after transplantation when diffuse and concentric vascular
changes can be easily detected only by intravascular
ultrasound. The treatment of the established vasculopathy
is disappointing, so the primary effort should be directed
toward early prevention and diagnosis. Due to diffuse vascular
changes, revascularization procedures are restricted
only to a relatively small proportion of patients with favorable
coronary anatomy. Percutaneous coronary intervention
is preferred over surgical revascularization since it leads to
better acute results and patient survival. Although there is
no proven long-term advantage of drug-eluting stents for
the treatment of in-stent restenosis, they are preferred over
bare-metal stents. Severe vasculopathy has a poor prognosis
and the only definitive treatment is retransplantation.
This article reviews the present knowledge on the pathogenesis,
diagnosis, treatment, and prognosis of cardiac allograft
vasculopathy.
Ključne riječi
Hrčak ID:
139284
URI
Datum izdavanja:
15.12.2014.
Posjeta: 1.406 *