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May experience spontaneous remission.CAD IN CARDIAC TRANSPLANT RECIPIENTS Orthotopic transplanted hearts develop an accelerated form of coronary vasculopathy, usually detected by serial coronary angiography or intravascular ultrasound studies, that is a leading cause of death after the first post-transplant year (25,26). The coronary disease is different from that seen in non-transplanted hearts with coronary atherosclerosis; the disease is diffuse and characterized by pronounced intimal thickening and involvement of the entire coronary tree. Discrete stenoses of epicardial arteries can coexist in some instances. Cardiac allografts are denervated, and although some recipients may develop a degree of sympathetic reinnervation, acute coronary syndromes may present with atypical symptoms as opposed to angina (27). Noninvasive testing for CAD is less sensitive in the transplant recipient; many patients do not achieve VO2max, and cardiac denervation can limit peak heart rate response and symptoms. Provocative myocardial perfusion imaging can fail to detect ischemia (25,27) although dobutamine echocardiography has been shown to predict subsequent ischemic cardiac events (26,28–31) after the first three to five years posttransplant. In many cardiac transplant centers, a normal stress echocardiogram justifies postponement of annual coronary angiography (26,28–31). Coronary angiography can also underestimate disease severity because of the diffuse nature of the CAD process; intravascular ultrasound studies increase the sensitivity (26). Evaluation. 1. Cardiac transplant recipients participating in competitive athletics should undergo yearly maximal exercise testing with echocardiography using a protocol designed to simulate the cardiac and metabolic demands of the competitive event and its training. 2. Additional evaluation, including such procedures as coronary angiography and intravascular ultrasonography (IVUS) should be performed as directed by the transplant center and the transplant cardiologist. Coronary angiography/IVUS should also be performed if the annual exercise test is abnormal and to evaluate unexplained symptoms such as dyspnea or exertional fatigue as these may be the only symptoms of progressive vascular disease. 1351 JACC Vol. 45, No. 8, 2005 Thompson et al. April 19, 2005:1348–53 Task Force 6: Coronary Artery Disease Recommendations: Because of the special issues involved with transplant Patient management, decisions as to the feasibility of Athletic competition for cardiac transplant recipients should be made in conjunction with the patient’s Transplant cardiologist. Athletes with no coronary luminal narrowing, no Exercise-induced ischemia, and with normal exercise Tolerance for age (as previously defined ) can generally Participate in all competitive sports as appropriate For their exercise capacity. Athletes with coronary luminal narrowing should be Risk stratified as outlined in the section entitled Date: 2016-03-03; view: 1056
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