Abstract 9717: The New ISHLT Cardiac Allograft Vasculopathy Coronary Angiogram Grading Scale: Does it Have Prognostic Relevance?
Purpose: The International Society for Heart and Lung Transplantation (ISHLT) has recently established a cardiac allograft vasculopathy (CAV) nomenclature scale to standardize coronary angiography reporting. In general, the new grading scheme is represented by CAV0, no disease; CAV1, mild disease; CAV2, moderate disease; CAV3, severe disease. Restrictive cardiac physiology associated with CAV1 or CAV2 will automatically place them into CAV3. It has not been established whether increasing CAV grade truly correlates to worse outcome after heart transplantation. In addition, the impact of restrictive cardiac physiology (in this grading scheme) on outcome has not been well established.
Methods: Between 1994 and 2010, we reviewed 1,341 heart transplant patients (pts) and divided them according to first diagnosis of an abnormal specific CAV grade. All pts were then subsequently followed for 5 year actuarial survival after first diagnosis of that specific CAV grade. We also assessed the impact of restrictive physiology on subsequent actuarial 5-year survival in the CAV3 group.
Results: 5-year subsequent actuarial survival following first time diagnosis of CAV category showed worsening survival from CAV1 (n=219), CAV2 (n=96), CAV3 (n=50) pts (80%, 63%, 52% respectively, p<0.001)(figure). In the CAV3 group, pts with restrictive cardiac physiology had worse 5-year subsequent actuarial survival compared to those without (41% vs. 58%, p=0.07).
Conclusion: The new ISHLT CAV nomenclature grading scale appears to predict outcome after heart transplant. Addition of restrictive cardiac physiology as inclusion criteria for CAV3 grade appears justified as it infers worse prognosis.
- © 2012 by American Heart Association, Inc.