TITLE:
Non-Invasive Assessment of Coronary Microcirculation in Heart Transplantation
AUTHORS:
Laura De Michieli, Carlo Dal Lin, Francesco Tona
KEYWORDS:
Heart Transplantation, Coronary Microcirculation, Imaging, Rejection, Echocardiography
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.9 No.11,
November
19,
2019
ABSTRACT: Heart transplantation (HT)
is an accepted treatment for end-stage heart failure (HF). Heart
transplantation significantly increases survival, exercise capacity, quality of
life and return to work in selected patients with advanced heart failure
compared with conventional treatment. The survival rates have improved with the
use of new immunosuppressive drugs, with a
median survival after transplantation of approximately 11 years. The
shortage of donor hearts represents a
major limitation in this field. In addition
many are the consequences of the limited effectiveness and complications of
immunosuppressive therapy (i.e. antibody-mediated rejection, infection, hypertension, renal failure, malignancy
and coronary artery vasculopathy). In
particular, chronic rejection may occur months to years after the
transplantation and is referred to as cardiac allograft vasculopathy (CAV). CAV
occurs in 32% of the patients after 5 years and ensuing allograft failure from
CAV eventually accounts for 30% of recipient deaths after transplantation.
Cardiac allograft vasculopathy, involving coronary macro- and microcirculation,
is caused by complicated interplay
between immunologic and non-immunologic factors resulting in repetitive
endothelial injury and localized sustained inflammatory response. Early
diagnosis of microvascular dysfunction is substantial. In this review we analyze signs and symptoms of CAV
presentation and the different methodologies to achieve an early and precise
diagnosis. We will discuss invasive and non-invasive diagnostic tools and their
specific role in evaluating graft’s function, morphology, the presence of
coronary artery disease and possible microcirculation involvement.