title: Recent developments on coronary microvasculopathy after heart transplantation: a new target in the therapy of cardiac allograft vasculopathy.
abstract: Heart transplantation (HTx) is the treatment of choice for patients with refractory end-stage heart diseases. Although the procedure is considered effective in extending and improving quality of life, the onset of cardiac allograft vasculopathy (CAV) continues to limit the long-term success of HTx. Emerging data indicate that the endothelium plays a significant role in the onset, progression and complication of this multifactorial disease, with both immunologic and nonimmunologic risk factors contributing to its development. Improving our understanding of the integral role of the coronary microcirculation in CAV is of crucial clinical interest since it could provide further insights into the related pathophysiological mechanisms and possible new strategies for CAV prevention and therapy. Assessment of coronary microvasculopathy has been shown to be of predictive value after HTx. Predominant allograft microvascular dysfunction is detectable in 15-20% of patients after HTx. Very recently, stenotic microvasculopathy (detected in biopsy samples) has been characterized as a prognostic factor for long-term survival after HTx. The ability to detect and distinguish changes in epicardial and microvascular function may aid in identifying modifiable factors that lead to CAV. Improved immunosuppressive drugs, including mycophenolate mofetil and proliferation signal inhibitors, as well as statins (in part via immunomodulation), may have a beneficial effect on coronary microcirculation after HTx, although there is still a need to confirm the impact of vasodilators in improving the prognosis of HTx patients. We review the role of coronary microvasculopathy in HTx, its prevention and new potential pharmacological interventions.
authors.affiliation: Division of Cardiology, Department of Cardiological, Thoracic and Vascular Sciences, Centro "V. Gallucci" University of Padova-Policlinico, Padova, Italy. francescotona@hotmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Tona
authors.forename: Martina Perazzolo
authors.initials: MP
authors.lastname: Marra
authors.forename: Marny
authors.initials: M
authors.lastname: Fedrigo
authors.forename: Giulia
authors.initials: G
authors.lastname: Famoso
authors.forename: Roberto
authors.initials: R
authors.lastname: Bellu
authors.forename: Gaetano
authors.initials: G
authors.lastname: Thiene
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
authors.forename: Annalisa
authors.initials: A
authors.lastname: Angelini
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
mesh_terms: D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology; D018450:Disease Progression; D006331:Heart Diseases / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D008833:Microcirculation; D055806:Microvessels / Q000473:pathology; D011237:Predictive Value of Tests; D011788:Quality of Life; D012307:Risk Factors; D015996:Survival Rate; D014652:Vascular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control