Cardiac allograft vasculopathy: diagnosis, therapy, and prognosis.
Cardiac allograft vasculopathy: diagnosis, therapy, and prognosis.
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DOI：
10.3325/cmj.2014.55.562
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发表时间：
2014-12
影响因子：
1.9
通讯作者：
Miličić D
中科院分区：
文献类型：
--
作者：
Skorić B;Čikeš M;Ljubas Maček J;Baričević Ž;Škorak I;Gašparović H;Biočina B;Miličić D
心脏移植物血管病变的发展是心脏移植患者长期生存的主要决定因素。由于移植物去神经支配，这些患者很少出现典型的心绞痛症状，并且第一临床表现是进行性心力衰竭或心源性猝死。虽然冠状动脉造影术仍然是冠状动脉疾病检测的常规技术，但它对于筛查目的不够敏感。尤其是在移植后的第一年，弥漫性和同心性血管变化仅通过血管内超声即可轻易检测到。对已确诊的血管病变的治疗是令人失望的，所以主要的努力应该是针对早期预防和诊断。由于弥漫性血管变化，血运重建手术仅限于相对较小比例的冠状动脉解剖结构良好的患者。经皮冠状动脉介入治疗优于外科血运重建术，因为它导致更好的急性结果和患者生存率。尽管药物洗脱支架治疗支架内再狭窄的长期优势尚未得到证实，但其优于裸金属支架。严重的血管病变预后差，唯一确定的治疗方法是再次移植。本文就移植心脏血管病的发病机制、诊断、治疗和预后等方面的研究进展作一综述。
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.
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