Abstract:
:Over the last 4 decades, heart transplantation (HTx) has evolved as a mainstream therapy for heart failure. Approximately half of patients needing HTx have organ failure consequent to atherosclerosis. Despite advances in immunosuppressive drugs, long-term success of HTx is limited by the development of a particular type of coronary atherosclerosis, referred to as cardiac allograft vasculopathy (CAV). Although the exact pathogenesis of CAV remains to be established, there is strong evidence that CAV involves immunologic mechanisms operating in a milieu of nonimmunologic risk factors. The immunologic events constitute the principal initiating stimuli, resulting in endothelial injury and dysfunction, altered endothelial permeability, with consequent myointimal hyperplasia and extracellular matrix synthesis. Lipid accumulation in allograft arteries is prominent, with lipoprotein entrapment in the subendothelial tissue, through interactions with proteoglycans. The apparent endothelial "intactness" in human coronary arteries of the transplanted heart suggest that permeability and function of the endothelial barrier altered. Various insults to the vascular bed result in vascular smooth muscle cell (SMC) activation. Activated SMCs migrate from the media into the intima, proliferate, and elaborate cytokines and extracellular matrix proteins, resulting in luminal narrowing and impaired vascular function. Arteriosclerosis is a broad term that is used to encompass all diseases that lead to arterial hardening, including native atherosclerosis, postangioplasty restenosis, vein bypass graft occlusion, and CAV. These diseases exhibit many similarities; however, they are distinct from one another in numerous ways as well. The present review summarizes the current understanding of the risk factors and the pathophysiological similarities and differences between CAV and atherosclerosis.
journal_name
Circ Resjournal_title
Circulation researchauthors
Rahmani M,Cruz RP,Granville DJ,McManus BMdoi
10.1161/01.RES.0000246086.93555.f3subject
Has Abstractpub_date
2006-10-13 00:00:00pages
801-15issue
8eissn
0009-7330issn
1524-4571pii
99/8/801journal_volume
99pub_type
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更新日期:2007-10-26 00:00:00
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更新日期:2012-03-02 00:00:00
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更新日期:1976-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:2008-02-15 00:00:00
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pub_type: 杂志文章
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更新日期:1992-02-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:1987-07-01 00:00:00
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更新日期:1993-09-01 00:00:00
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pub_type: 杂志文章
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更新日期:1975-12-01 00:00:00
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更新日期:2004-05-14 00:00:00
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更新日期:2016-10-28 00:00:00
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更新日期:2017-03-03 00:00:00
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更新日期:2019-02-01 00:00:00
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pub_type: 杂志文章
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更新日期:1998-08-24 00:00:00
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更新日期:1998-07-13 00:00:00
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更新日期:2001-11-23 00:00:00
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更新日期:2011-10-28 00:00:00