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ISHLT cardiac allograft vasculopathy nomenclature

ISHLT cardiac allograft vasculopathy nomenclature
ISHLT CAV0 (Not significant): No detectable angiographic lesion.
ISHLT CAV1 (Mild): Angiographic LM <50 percent, primary vessel with maximum lesion of <70 percent, or any branch stenosis <70 percent (including diffuse narrowing) without allograft dysfunction.
ISHLT CAV2 (Moderate): Angiographic LM ≥50 percent*, a single primary vessel ≥70 percent, or isolated branch stenosis ≥70 percent in branches of two systems, without allograft dysfunction.
ISHLT CAV3 (Severe): Angiographic LM ≥50 percent, two or more primary vessels ≥70 percent stenosis, or isolated branch stenosis ≥70 percent in all three systems; or ISHLT CAV1 or CAV2 with allograft dysfunction (defined as LVEF ≤45 percent) or evidence of significant restrictive physiology.
(A) A "primary vessel" denotes the proximal and middle 33 percent of the left anterior descending artery, the left circumflex, the ramus, and the dominant or co-dominant right coronary artery with the posterior descending and posterolateral branches.
(B) A "secondary branch vessel" includes the distal 33 percent of the primary vessels or any segment within a large septal perforator, diagonals and obtuse marginal branches, or any portion of a non-dominant right coronary artery.
(C) Restrictive cardiac allograft physiology is defined as symptomatic heart failure with echocardiographic E to A velocity ratio >2 (>1.5 in children), shortened isovolumetric relaxation time (<60 msec), shortened deceleration time (<150 msec), or restrictive hemodynamic values (right atrial pressure >12 mmHg, pulmonary capillary wedge pressure >25 mmHg, cardiac index <2 L/min/m2).
LM: left main coronary artery stenosis; ISHLT: International Society of Heart and Lung Transplant; LVEF: left ventricular ejection fraction.
* Normal graft function.
Reproduced from: Mehra M, Crespo-Leiro M, Dipchand A, et al. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010. J Heart Lung Transplant 2010; 29:717. Illustration used with the permission of Elsevier Inc. All rights reserved.
Graphic 70548 Version 4.0

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