Strategies To Prevent Cardiac Allograft Vasculopathy Related Events in Heart Transplant Recipients

1. Early initiation of sirolimus will prevent or delay the development of intimal thickening and subsequent graft failure. 2. Treatment guided by the development of cardiac allograft vasculopathy (CAV) on intravascular ultrasound (IVUS) will be more effective in delaying progression of CAV compared to treatment guided by angiography. 3. Prevention of the development and progression of intimal thickness on IVUS will prevent the development of heart failure, graft dysfunction, and cardiovascular death related to CAV. 4. Small artery elasticity predicts progression of cardiac allograft vasculopathy and is modified by sirolimus 5. Patients who have no progression of CAV will have favorable improvement in biomarkers and endothelial cells compared to patients who have progression of CAV