Cardiac Transplant
- Clinical:
Complications:
Coronary artery vasculopathy (CAV) develops in 10% of cardiac transplant patients at one year and 50% by 5 years post transplant [1]. The disease is characterized by concentric and diffuse arterial hyperplasia and thus may be underestimated by coronary angiography [1]. Anginal symptoms are usually lacking due to denervation and the first clinical signs are frequently severe with heart failure, infarction, ventricular arrhythmia, or sudden death [2]. The diffuse nature of the process renders conventional coronary revascularization less useful and re-transplantation is the only definitive therapy [1]. Currently, CAV is felt to be the result of immunological differences between the graft and host, leading to immunologically mediated arterial hyperplasia [1].
-X-ray:
Multidetector coronary CT has an advantage over conventional angiography for the detection of CAV [1]. SPECT imaging can detect perfusion abnormalities secondary to CAV [2].
REFERENCES:
(1) J Nucl Cardiol 2010; Soman P, et al. Surveillance for post-transplant coronary artery vasculopathy: shifting gears from diagnosis to prognosis. 17: 172-174
(2) J Nucl Cardiol 2010; Manrique A, et al. Diagnostic and prognostic value of myocardial perfusion gated SPECT in orthotopic heart transplant recipients. 17: 197-206
