New ISHLT Cardiac Allograft Vasculopathy Standardized Nomenclature: A Common International Definition Will Benefit Heart Transplant Patients

Consensus Statement Published in The Journal of Heart and Lung Transplantation

New York, 25 June, 2010 – Cardiac allograft vasculopathy (CAV), the major limitation to long term survival after heart transplantation, occurs when blood vessels in a transplanted heart progressively narrow and lead to dysfunction of the heart muscle or sudden death. Ascertaining benefit from appropriate treatment for this condition has been hampered in part because of the lack of a standard nomenclature. In an article published online today in The Journal of Heart and Lung Transplantation (www.jhltonline.org), clinicians representing the International Society for Heart and Lung Transplantation (ISHLT) Working Group on Classification of Cardiac Allograft Vasculopathy issued the first international consensus formulation of a standardized nomenclature for CAV.

“The development of cardiac allograft vasculopathy remains the Achilles heel of cardiac transplantation,” commented working group leader, Mandeep R. Mehra, MD, Herbert Berger Professor and Head of Cardiology, University of Maryland School of Medicine, Baltimore, MD. “Unfortunately, the definitions of cardiac allograft vasculopathy are diverse and confusion abounds. There have been no uniform international standards for the nomenclature of this entity. The lack of a standard language has led to confusion in the interpretation of various studies and several unanswered questions persist. The ISHLT consensus statement is the first step in resolving these issues and improving cardiac transplant patient outcomes.”

This consensus document, commissioned by the International Society for Heart and Lung Transplantation Board, is based on best evidence and clinical consensus derived from critical analysis of available information pertaining to angiography, intravascular ultrasound imaging, microvascular function, cardiac allograft histology, circulating immune markers, noninvasive imaging tests, and gene-based and protein-based biomarkers.

ISHLT President, John Dark, FRCS, stated, “The consensus document from the international working group led by Dr. Mehra defines the descriptors of the major clinical challenge late after cardiac transplantation. It also defines the ISHLT as the organization unifying all those, scientists and clinicians, working in this field, and able to put the stamp of authority on the recommendations. The topic is rapidly evolving, but Dr Mehra and his colleagues have undertaken to keep the data under close review. We can anticipate further definitive analyses in the future."

This article presents 5 consensus statements that describe how to best identify CAV and assess its severity. By developing a standard nomenclature, appropriate treatment options can be selected, depending on the level of CAV. Four levels of CAV are defined, ranging from CAV0 (not significant), where no angiographic lesions are detected, to CAV3 (severe), where multiple major heart vessels are involved. Key among the recommendations to define the severity of CAV is to view the anatomy of the allograft vasculature in concert with the physiological effects of the disease on cardiac allograft function.

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Notes To Editors
The article is “International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy—2010” by Mandeep R. Mehra, MD, Maria G. Crespo-Leiro, MD, Anne Dipchand, MD, Stephan M. Ensminger, MD, PhD, Nicola E. Hiemann, MD, Jon A. Kobashigawa, MD, Joren Madsen, MD, PhD, Jayan Parameshwar, MD, Randall C. Starling, MD, MPH, and Patricia A. Uber, BS, PharmD. doi: 10.1016/j.healun.2010.05.017. The article appears in The Journal of Heart and Lung Transplantation, Volume 29, Issue 7 (July 2010), p 717-727, published by Elsevier. The article is freely available at www.jhltonline.org.

A pdf of the full text of the article is available upon request to journalists prior to the embargo lifting; contact Linda Gruner at jhltmedia@elsevier.com or 212-633-3923.

To obtain additional information from the ISHLT regarding the consensus on cardiac allograft vasculopathy or to arrange an author interview, please contact:

Mandeep R. Mehra, MD
Herbert Berger Professor and Head of Cardiology
University of Maryland School of Medicine
Tel: 410-328-7716.
Fax: 410-328-4382.
E-mail: mmehra@medicine.umaryland.edu

From the ISHLT Working Group on Classification of Cardiac Allograft Vasculopathy commissioned by the Education Committee and Board of Directors of the Society

Authors
Mandeep R. Mehra, MD
Maria G. Crespo-Leiro, MD
Anne Dipchand, MD
Stephan M. Ensminger, MD, PhD
Nicola E. Hiemann, MD
Jon A. Kobashigawa, MD
Joren Madsen, MD, PhD
Jayan Parameshwar, MD
Randall C. Starling, MD, MPH
Patricia A. Uber, BS, PharmD

About the Journal of Heart and Lung Transplantation
A forum that includes all aspects of pre-clinical and clinical science of the failing heart and lung

The Official Publication of the International Society for Heart and Lung Transplantation (www.ishlt.org), brings readers essential scholarly and timely information in the field of cardiopulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy; Importantly, the Journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.

About The International Society for Heart and Lung Transplantation (ISHLT)
The International Society for Heart and Lung Transplantation (www.ishlt.org) is a not-for-profit organization dedicated to the advancement of the science and treatment of end-stage heart and lung diseases. ISHLT was created in 1981 at a small gathering of about 15 cardiologists and cardiac surgeons. Today, ISHLT has over 2200 members from over 45 countries, representing over 10 different disciplines involved in the management and treatment of end-state heart and lung disease. Despite their differing specializations, all ISHLT members share a common dedication to the advancement of the science and treatment of end-stage heart and lung disease.

This multinational, multidisciplinary mix is one of the biggest strengths of the Society. It brings greater breadth and depth to ISHLT's educational offerings and provides an exceptional environment for networking and exchanging information on an informal basis.

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com

Media Contact
Linda Gruner
Elsevier
+! 212-633-3923
jhltmedia@elsevier.com