Cardiac allograft vasculopathy (CAV), the major limitation to long term survival after heart transplantation, occurs when blood vessels in a transplanted heart progressively narrow and lead to dysfunction of the heart muscle or sudden death.
Ascertaining benefit from appropriate treatment for this condition has been hampered in part because of the lack of a standard nomenclature. In an article published online today in The Journal of Heart and Lung Transplantation (www.jhltonline.org), clinicians representing the International Society for Heart and Lung Transplantation (ISHLT) Working Group on Classification of Cardiac Allograft Vasculopathy 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," commented working group leader, Mandeep R. Mehra, MD, Herbert Berger Professor and Head of Cardiology, University of Maryland School of Medicine, Baltimore, MD. "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 ISHLT consensus statement is the first step in resolving these issues and improving cardiac transplant patient outcomes."
This consensus document, commissioned by the International Society for Heart and Lung Transplantation Board, is based on best evidence and clinical consensus derived from critical analysis 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.
ISHLT President, John Dark, FRCS, stated, "The consensus document from the international working group led by Dr. Mehra 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. The topic is rapidly evolving, but Dr Mehra and his colleagues have undertaken to keep the data under close review. We can anticipate further definitive analyses in the future."
This article presents 5 consensus statements that describe how to best identify CAV and assess its severity. By developing a standard nomenclature, appropriate treatment options can be selected, depending on the level of CAV. Four levels of CAV are defined, ranging from CAV0 (not significant), where no angiographic lesions are detected, to CAV3 (severe), where multiple major heart vessels are involved. Key among the recommendations to define the severity of CAV is to view the anatomy of the allograft vasculature in concert with the physiological effects of the disease on cardiac allograft function.
The article is "International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy—2010" by Mandeep R. Mehra, MD, Maria G. Crespo-Leiro, MD, Anne Dipchand, MD, Stephan M. Ensminger, MD, PhD, Nicola E. Hiemann, MD, Jon A. Kobashigawa, MD, Joren Madsen, MD, PhD, Jayan Parameshwar, MD, Randall C. Starling, MD, MPH, and Patricia A. Uber, BS, PharmD. doi: 10.1016/j.healun.2010.05.017. The article appears in The Journal of Heart and Lung Transplantation, Volume 29, Issue 7 (July 2010), p 717-727, published by Elsevier. The article is freely available at www.jhltonline.org.
Correct connections are crucial
26.06.2017 | Charité - Universitätsmedizin Berlin
One gene closer to regenerative therapy for muscular disorders
01.06.2017 | Cincinnati Children's Hospital Medical Center
An international team of scientists has proposed a new multi-disciplinary approach in which an array of new technologies will allow us to map biodiversity and the risks that wildlife is facing at the scale of whole landscapes. The findings are published in Nature Ecology and Evolution. This international research is led by the Kunming Institute of Zoology from China, University of East Anglia, University of Leicester and the Leibniz Institute for Zoo and Wildlife Research.
Using a combination of satellite and ground data, the team proposes that it is now possible to map biodiversity with an accuracy that has not been previously...
Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.
Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...
Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.
As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...
Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.
With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...
Temperature measurements possible even on the smallest scale / Molecular ruby for use in material sciences, biology, and medicine
Chemists at Johannes Gutenberg University Mainz (JGU) in cooperation with researchers of the German Federal Institute for Materials Research and Testing (BAM)...
19.06.2017 | Event News
13.06.2017 | Event News
13.06.2017 | Event News
27.06.2017 | Power and Electrical Engineering
27.06.2017 | Information Technology
27.06.2017 | Physics and Astronomy