Working Toward an International Definition for Cardiac Allograft Vasculopathy

Cardiac allograft vasculopathy (CAV) is the major limitation to long-term survival for heart transplant patients, which can cause heart muscle dysfunction or sudden death. A group of researchers, led by Mandeep R. Mehra, MD, Herbert Berger Professor and Head of Cardiology at the University of Maryland School of Medicine, have issued the first international consensus formulation of a standardized nomenclature for CAV.

"The development of cardiac allograft vasculopathy remains the Achilles heel of cardiac transplantation," said Mehra. "Unfortunately, the definitions of cardiac allograft vasculopathy are diverse and confusion abounds. There have been no uniform international standards for the nomenclature of this entity. The lack of a standard language has led to confusion in the interpretation of various studies and several unanswered questions persist."

The article "International Society for Heart and Lung Transplantation Working Formulation of A Standardized Nomenclature for Cardiac Allograft Vasculopathy - 2010" was published by Mehra and colleagues in The Journal of Heart and Lung Transplantation. The consensus document uses critical analyses of available information pertaining to angiography, intravascular ultrasound imaging, microvascular function, cardiac allograft histology, circulating immune markers, noninvasive imaging tests, and gene-based and protein-based biomarkers. It presents five consensus statements about the best way to identify CAV and suggests that the development of a standard nomenclature for CAV would enable “appropriate treatment options” to be selected depending on the severity of the CAV. The consensus statement also defines four levels of CAV, “ranging from CAV0 (not significant), where no angiographic lesions are detected, to CAV3 (severe), where multiple major heart vessels are involved.”

John Dark, FRCS, president of the International Society for Heart and Lung Transplantation (ISHLT), said that the consensus document “defines the descriptors of the major clinical challenge late after cardiac transplantation. It also defines the ISHLT as the organization unifying all those, scientists and clinicians, working in this field, and able to put the stamp of authority on the recommendations.”