WEDNESDAY, June 30 (HealthDay News) -- The first international consensus formulation of a standardized nomenclature to define and describe post-heart-transplant cardiac allograft vasculopathy (CAV) has been issued by clinicians representing the International Society for Heart and Lung Transplantation Working Group on Classification of Cardiac Allograft Vasculopathy, and published in the July issue of the Journal of Heart and Lung Transplantation.
Mandeep R. Mehra, M.D., of the University of Maryland School of Medicine in Baltimore, and colleagues issued the consensus document because the lack of a standard language has led to confusion in the interpretation of various studies regarding CAV after heart transplant. The working group performed a critical review of the literature and expert opinion -- including that pertaining to angiography, intravascular and noninvasive imaging tests, microvascular function, cardiac allograft histology, immune markers, and gene- and protein-based biomarkers.
Five consensus statements are presented by the working group, which describe how to best identify CAV and evaluate its severity, using standard nomenclature. They propose that CAV be assigned to one of four severity levels, ranging from insignificant, with no angiographic evidence of CAV (CAV0), to severe, when multiple major vessels are involved (CAV3).
"There are no standards in the nomenclature of CAV. Much confusion abounds. An early attempt at angiographic classification was not widely adopted due to its lack of prognostic direction and was overshadowed by the advent of intravascular ultrasound technology. The lack of a standard language has led to confusion in the interpretation of various studies and several unanswered questions persist," the authors write.
Three authors disclosed financial relationships with pharmaceutical and/or biotechnology companies.