The Dark Triad trait of psychopathy and message framing predict risky decision-making during the COVID-19 pandemic.

The effects of framing on risky decision-making have been studied extensively in research using Kahneman and Tversky's (1981) hypothetical scenario about a contagious Asian disease. The COVID-19 pandemic offers a unique opportunity to test how message framing affects risky decision-making when millions of real lives are at stake worldwide. In a sample of US adults (N = 294), we investigated the effects of message framing and personality (Dark Triad traits) in relation to risky decision-making during the COVID-19 crisis. We found that both gain- and loss-framing influenced risk choice in response to COVID-19. People were more risk-averse in the loss condition of the current study compared to the benchmark established by Tversky and Kahneman (1981). Among the Dark Triad traits, psychopathy emerged as the significant predictor of risk taking, suggesting that people who score high in psychopathy are more likely to gamble with other people's lives during the COVID-19 crisis. We suggest that both voters and pandemic-related public awareness campaigns should consider the possibility that decision-makers with psychopathic tendencies may take greater risks with other people's lives during a pandemic. In addition, the framing of public-health messages should be tailored to increase the chances of compliance with government restrictions.

Structural and functional evolution of an auxin efflux carrier PIN1 and its functional characterization in common wheat.

Particularly PIN1, PIN protein-mediated rate-limiting auxin distribution plays a critical role in plant differentiation. Although well-characterized in Arabidopsis, little is known about the structural and functional relationship of the PIN1 gene among other plants. Here, we report that the gene structure remained conserved among bryophytes and angiosperms while the gene size varied by ~ 17%. Although the positions were conserved, highly variable intron phase suggests preference for specific regions in the gene sequence for independent events of intron insertion. Significant variation was observed across gene length for insertions and deletions that were mainly localized to the exonic regions flanking intron 1, possibly demarcating the sequences prone to deletions/duplications. The N and C-terminals showed a higher protein sequence similarity (~ 80%) compared to the central hydrophilic loop (~ 26%). In addition to the signature domains and motifs, we identified four novel uncharacterized motifs in the central divergent loop of PIN1 protein. Three different homo-loci, one each on chromosome groups 4, 6, and 7, were identified in wheat each showing dramatically different expression patterns during different plant developmental stages. Virus-induced gene silencing of the TaPIN1 gene resulted up to 26% reduction in plant height. Because of its direct role in controlling plant height along with a higher expression during stem elongation, the TaPIN1 gene can be manipulated to regulate plant height.

Sequencing-based high throughput mutation detection in bread wheat.

BACKGROUND: Forward genetic approaches have limited use for agronomic traits that can't be reliably scored on a single plant basis. Thus, mutants in wheat and other crops are more useful for gene function studies by reverse genetic approach. With a long-term goal to develop a sequence-based mutation detection resource in hexaploid wheat, we conducted a feasibility study to accurately differentiate induced mutations from the homoeologs' sequence variations present among the three wheat genomes. RESULTS: A reduced representation ApeKI library consisting of 21 Ethylmethane Sulfonate (EMS) induced mutants and two wild type cv. Indian plants was developed using individual barcode adapters and sequenced. A novel bioinformatics pipeline was developed to identify sequence variants using 178,464 wheat unigenes as a reference wheat transcriptome. In total, 14,130 mutational changes [Single Nucleotide Polymorphisms (SNPs) and Insertions/Deletions (INDELs)] and 150,511 homoeologous sequence changes were detected. On an average, 662 SNPs (ranging from 46 to 1,330) and 10 small INDELs (ranging from 0 to 23) were identified for each of the mutants. A mutation frequency of one per 5 Kb was observed with 70 % being transitions and 30 % transversions. The pipeline was tested using the known sequence changes in the three wheat genes. Genes present in the distal regions of the chromosomes were found to be more prone to EMS compared to genes present in the proximal regions. Redefined parameters identified a total of 28,348 mutational changes (1,349/plant). CONCLUSIONS: We conclude that sequencing based mutation detection is a valuable method to identify induced mutations at large.

Deciphering the Genome-Wide Transcriptomic Changes during Interactions of Resistant and Susceptible Genotypes of American Elm with Ophiostoma novo-ulmi.

Dutch elm disease (DED), caused by Ophiostoma novo-ulmi (Onu), is a destructive disease of American elm (Ulmus americana L.). The molecular mechanisms of resistance and susceptibility against DED in American elm are still largely uncharacterized. In the present study, we performed a de novo transcriptome (RNA-sequencing; RNA-Seq) assembly of U. americana and compared the gene expression in a resistant genotype, 'Valley Forge', and a susceptible (S) elm genotype at 0 and 96 h post-inoculation of Onu. A total of 85,863 non-redundant unigenes were identified. Compared to the previously characterized U. minor transcriptome, U. americana has 35,290 similar and 55,499 unique genes. The transcriptomic variations between 'Valley Forge' and 'S' were found primarily in the photosynthesis and primary metabolism, which were highly upregulated in the susceptible genotype irrespective of the Onu inoculation. The resistance to DED was associated with the activation of RPM1-mediated effector-triggered immunity that was demonstrated by the upregulation of genes involved in the phenylpropanoids biosynthesis and PR genes. The most significantly enriched gene ontology (GO) terms in response to Onu were response to stimulus (GO:0006950), response to stress (GO:0050896), and secondary metabolic process (GO:0008152) in both genotypes. However, only in the resistant genotype, the defense response (GO:0006952) was among the topmost significantly enriched GO terms. Our findings revealed the molecular regulations of DED resistance and susceptibility and provide a platform for marker-assisted breeding of resistant American elm genotypes.

Reduction in BNP levels with treatment of decompensated heart failure and future clinical events.

BACKGROUND: Brain natriuretic peptide (BNP) levels correlate with outcomes in patients with heart failure (HF). We sought to compare the relationship between absolute and relative changes in BNP with future clinical events, and whether serial BNP measurements add prognostic information in patients treated for decompensated HF. METHODS AND RESULTS: In 203 patients treated for HF, increasing tertiles of BNP levels after treatment had a hazard ratio of 1.4 (1.1-1.7, P < .01) and increasing tertiles of percent reduction in BNP, had a hazard ratio of 0.7 (0.6-0.9, P = .005), respectively, for the combined end point of total mortality or readmission for HF. Higher baseline BNP levels did not decrease to lower BNP levels as often as lower BNP levels (P < .001). Follow-up BNP performed better in a model, incorporating age, ejection fraction, prior HF hospitalization, New York Heart Association Class, race, use of beta-blockers and renin-angiotensin axis inhibitors and renal insufficiency, than did baseline BNP or percent reduction in BNP. More BNP measurements other than the follow-up BNP did not improve the fit of the model further. CONCLUSIONS: These results suggest that both lower absolute BNP levels and greater percentage reduction in BNP with treatment of decompensated HF are associated with better event-free survival. Advocating a threshold BNP to which patients should be treated may not be possible given that high BNP levels tend not to decrease to levels associated with better outcomes during the short period of treatment. More BNP measurements do not add prognostic information beyond that provided by a single BNP level after treatment.

Molecular Characterization of Auxin Efflux Carrier- ABCB1 in hexaploid wheat.

Auxin is an important phytohormone that regulates response, differentiation, and development of plant cell, tissue, and organs. Along with its local production, long-distance transport coordinated by the efflux/influx membrane transporters is instrumental in plant development and architecture. In the present study, we cloned and characterized a wheat (Triticum aestivum) auxin efflux carrier ABCB1. The TaABCB1 was physically localized to the proximal 15% of the short arm of wheat homoeologous group 7 chromosomes. Size of the Chinese spring (CS) homoeologs genomic copies ranged from 5.3-6.2 kb with the 7A copy being the largest due to novel insertions in its third intron. The three homoeologous copies share 95-97% sequence similarity at the nucleotide, 98-99% amino acid, and overall Q-score of 0.98 at 3-D structure level. Though detected in all analyzed tissues, TaABCB1 predominantly expressed in the meristematic tissues likely due to the presence of meristem-specific activation regulatory element identified in the promoter region. RNAi plants of TaABCB1 gene resulted in reduced plant height and increased seed width. Promoter analysis revealed several responsive elements detected in the promoter region including that for different hormones as auxin, gibberellic acid, jasmonic acid and abscisic acid, light, and circadian regulated elements.

Seasonal Variation of Allergenic Acarofauna From the Homes of Allergic Rhinitis and Asthmatic Patients.

House dust mites (HDMs) play positive role in causing various kinds of allergenic manifestations such as allergic rhinitis (AR), asthma, dermatitis, and urticaria. HDMs are prevalent in temperate regions but various studies have shown the prevalence of HDMs in tropical and subtropical countries. The present study was conducted from March 2015 to February 2016. During the study period, a total of 500 dust samples were collected from 125 homes of 125 patients suffering from AR and asthma. From these 500 dust samples, 466 samples were found to be positive for mites. The year was divided into three climatic classes, i.e., CCL I (March, April, May, June), CCL II (July, August, September, October), and CCL III (November, December, January, February) A total of 7,710 mites were collected, from which 2,902 (37.63%) mites were found in samples collected during summer season, i.e., CCL-I, 3,728 (48.35%) mites were found in samples collected during rainy season, i.e., CCL-II and only 1,080 (14.01%) mites were found in samples collected during winter season, i.e., CCL-III. Total 7,710 mite specimens were isolated with 7,404, i.e., 96.03% were only from the hypoorder Astigmata, 240, i.e., 3.11% from suborder Prostigmata, 46, i.e., 0.60% from order Mesostigmata, and 20, i.e., 0.26% from suborder Oribatida. The present study indicates that Dermatophagoides pteronyssinus (Trouessart 1897) (Astigmata) was most abundant and frequently found allergenic mite species followed by D. farinae (Hughes 1961), D. microceras (Griffiths and Cunnington 1971), Acarus siro (Linnaeus 1758), Tyrophagus putrescentiae (Schrank 1781), Lepidoglyphus destructor (Schrank 1781), Euroglyphus maynei (Cooreman 1950), Cheyletus, Mesostigmatic, and Oribatida mites.

An Ethylmethane Sulfonate Mutant Resource in Pre-Green Revolution Hexaploid Wheat.

Mutagenesis is a powerful tool used for studying gene function as well as for crop improvement. It is regaining popularity because of the development of effective and cost efficient methods for high-throughput mutation detection. Selection for semi-dwarf phenotype during green revolution has reduced genetic diversity including that for agronomically desirable traits. Most of the available mutant populations in wheat (Triticum aestivum L.) were developed in post-green revolution cultivars. Besides the identification and isolation of agronomically important alleles in the mutant population of pre-green revolution cultivar, this population can be a vital resource for expanding the genetic diversity for wheat breeding. Here we report an Ethylmethane Sulfonate (EMS) generated mutant population consisting of 4,180 unique mutant plants in a pre-green revolution spring wheat cultivar 'Indian'. Released in early 1900s, 'Indian' is devoid of any known height-reducing mutations. Unique mutations were captured by proceeding with single M2 seed from each of the 4,180 M1 plants. Mutants for various phenotypic traits were identified by detailed phenotyping for altered morphological and agronomic traits on M2 plants in the greenhouse and M3 plants in the field. Of the 86 identified mutants, 75 (87%) were phenotypically stable at the M4 generation. Among the observed phenotypes, variation in plant height was the most frequent followed by the leaf morphology. Several mutant phenotypes including looped peduncle, crooked plant morphology, 'gritty' coleoptiles, looped lower internodes, and burnt leaf tips are not reported in other plant species. Considering the extent and diversity of the observed mutant phenotypes, this population appears to be a useful resource for the forward and reverse genetic studies. This resource is available to the scientific community.

Comparative analysis of ABCB1 reveals novel structural and functional conservation between monocots and dicots.

Phytohormone auxin plays a critical role in modulating plant architecture by creating a gradient regulated via its transporters such as ATP-binding cassette (ABC) B1. Except for Arabidopsis and maize, where it was shown to interrupt auxin transport, ABCB1's presence, structure and function in crop species is not known. Here we describe the structural and putative functional organization of ABCB1 among monocots relative to that of dicots. Identified from various plant species following specific and stringent criteria, ZmABCB1's "true" orthologs sequence identity ranged from 56-90% at the DNA and 75-91% at the predicted amino acid (aa) level. Relative to ZmABCB1, the size of genomic copies ranged from -27 to +1.5% and aa from -7.7 to +0.6%. With the average gene size being similar (5.8 kb in monocots and 5.7 kb in dicots), dicots have about triple the number of introns with an average size of 194 bp (total 1743 bp) compared to 556 bp (total 1667 bp) in monocots. The intron-exon junctions across species were however conserved. N-termini of the predicted proteins were highly variable: in monocots due to mismatches and small deletions of 1-13 aa compared to large, species-specific deletions of up to 77 aa in dicots. The species-, family- and group- specific conserved motifs were identified in the N-terminus and linker region of protein, possibly responsible for the specific functions. The near-identical conserved motifs of Nucleotide Binding Domains (NBDs) in two halves of the protein showed subtle aa changes possibly favoring ATP binding to the N-terminus. Predicted 3-D protein structures showed remarkable similarity with each other and for the residues involved in auxin binding.

Single versus double stenting for unprotected left main coronary artery bifurcation lesions: a systematic review and meta-analysis.

OBJECTIVES: We conducted a meta-analysis to assess outcomes for a single-stent (SS) strategy versus a double-stent (DS) strategy in treatment of distal unprotected left main coronary artery (ULMCA) lesions in the drug-eluting stent (DES) era. BACKGROUND: Routine use of DES implantation has contributed to improved outcomes in patients undergoing percutaneous coronary intervention (PCI) for disease involving the ULMCA. However, PCI for ULMCA bifurcation lesions continues to be technically demanding and is an independent predictor of poor outcomes. While a number of stenting techniques have been described, the optimal strategy remains unknown. METHODS: SS treatment was defined as stenting of the main branch alone and DS treatment as stenting of both the main and side branches. Our co-primary endpoints were major adverse cardiovascular events (MACE), and its individual components. RESULTS: We identified 7 observational studies involving 2328 patients. Mean duration of follow-up was 32 months. We adopted the random effect model when computing the combined odds ratio (OR). There was decreased risk of MACE with SS strategy (20.4%) versus DS strategy (32.8%) (OR, 0.51; 95% confidence interval [CI], 0.35-0.73). There was also decreased target vessel/target lesion revascularization (TLR/TVR) with SS strategy (10.1%) versus DS strategy (24.3%) (OR, 0.35; 95% CI, 0.25-0.49). CONCLUSION: Compared to the DS strategy of percutaneous ULMCA bifurcation intervention, an SS approach may be associated with better outcomes.

Worsening renal function is not associated with response to treatment in acute heart failure.

BACKGROUND: About a fourth of acute decompensated heart failure (ADHF) patients develop renal dysfunction during their admission. To date, the association of ADHF treatment with the development of worsening renal function (WRF) remains contentious. Thus, we examined the association of WRF with changes in BNP levels and with mortality. METHODS: We performed retrospective chart review of patients admitted with ADHF who had BNP, eGFR, creatinine and blood urea nitrogen (BUN) values measured both on admission and discharge. Survival analysis was conducted using Cox proportional hazards model and correlation was measured using Spearman's rank correlation test. RESULTS: 358 patients admitted for ADHF were evaluated. WRF was defined as >20% reduction in eGFR from admission to discharge and response to treatment was assessed by ΔBNP. There was a statistically significant reduction in BNP and increase in BUN during the admission. ΔBNP did not correlate with either ΔGFR or ΔBUN. Patients who developed WRF and those who did not, had a similar reduction in BNP. On univariate survival analysis, ΔBUN, but not ΔeGFR, was associated with 1-year mortality. In multivariate Cox proportional hazards model, BUN at discharge was associated with 1-year mortality (HR: 1.02, p<0.001), but ΔeGFR and ΔBUN were not associated with the primary endpoint. CONCLUSION: During ADHF treatment, ΔBNP was not associated with changes in renal function. Development of WRF during ADHF treatment was not associated with mortality. Our study suggests that development of WRF should not preclude diuresis in ADHF patients in the absence of volume depletion.

Impact of alpha 1-adrenergic antagonist use for benign prostatic hypertrophy on outcomes in patients with heart failure.

Previous clinical trials have shown that alpha(1)-adrenergic antagonists are not effective in subjects with heart failure (HF) and might increase HF rates when used for hypertension. However, alpha(1)-adrenergic antagonists may be prescribed to subjects with HF who have symptomatic benign prostatic hyperplasia. We sought to determine any association between alpha(1)-adrenergic antagonist use, commonly prescribed for benign prostatic hyperplasia, and the clinical outcomes of subjects with HF receiving contemporary therapy. An existing database of 388 subjects with decompensated HF admissions from 2002 to 2004 at the Veterans Affairs Hospital was analyzed according to the use of alpha(1)-adrenergic antagonists at discharge. Covariate-adjusted Cox proportional hazard models were used to examine any association with future admissions for decompensated HF and total mortality. Alpha-1-adrenergic antagonist therapy was prescribed in 25% of our HF population, predominantly for benign prostatic hyperplasia, and was not associated with significant increases in the combined risk of all-cause mortality and rehospitalization for HF (hazard ratio 1.24, 95% confidence interval 0.93 to 1.65, p = 0.14), HF hospitalization (hazard ratio 1.20, 95% confidence interval 0.85 to 1.70, p = 0.31), or all-cause mortality (hazard ratio 1.10, 95% confidence interval 0.78 to 1.56, p = 0.57). In patients not receiving beta-blocker therapy, alpha(1)-adrenergic antagonist therapy was significantly associated with increased HF hospitalizations (hazard ratio 1.94, 95% confidence interval 1.14 to 3.32, p = 0.015). In conclusion, in patients with chronic HF, the use of alpha(1)-adrenergic antagonists was significantly associated with more HF hospitalizations when prescribed without concomitant beta blockade. Thus, background beta-blocker therapy appears to be protective against the potential harmful effects of alpha(1)-adrenergic antagonist therapy in patients with HF.

Does the level of experience of residents affect outcomes of coronary artery bypass surgery?

BACKGROUND: At our institution, coronary artery bypass grafting (CABG) operations are performed by staff surgeons or by first- or second-year cardiothoracic residents under the direct supervision of attending surgeons. We evaluated the influence of surgical seniority on outcomes. METHODS: Using prospectively collected data from our departmental database, we identified all primary, isolated CABG operations (n = 1,042) performed between July 1997 and April 2007. Operations were then stratified according to the seniority of the primary surgeon: first-year cardiothoracic resident (CT1), second-year cardiothoracic resident (CT2), or staff surgeon. Data were examined for any association between seniority and surgical outcomes. RESULTS: Staff, CT2, and CT1 surgeons performed 47 (4%), 610 (59%), and 385 (37%) cases, respectively. Efficiency was correlated with experience: for CT1, CT2, and staff surgeons, respectively, operative times averaged 345, 313, and 302 minutes; perfusion times averaged 118, 106, and 96 minutes; and cross-clamp times averaged 68, 58, and 57 minutes (p < 0.05 for all comparisons). The incidences of major morbidity (10.1%, 12.3%, 12.8%) and operative mortality (0.8%, 1.5%, 2.1%) were similar after operations performed by CT1, CT2, and staff surgeons, respectively (p > 0.15 for all). In univariate and multivariate analyses, the seniority of the primary surgeon did not independently predict morbidity or perioperative mortality. On follow-up (mean, 1,485 +/- 1,015 days), there was no significant difference in patient survival (log-rank, p = 0.64). CONCLUSIONS: Lower academic seniority was associated with longer CABG operative times but did not affect outcomes. Thus, training residents to perform CABG is safe and is characterized by progressive improvement in their technical efficiency.

Prognostic impact of intra-aortic balloon pump insertion before versus after cardiac surgical intervention in a veteran population.

BACKGROUND: The relative prognostic impact of intra-aortic balloon pump (IABP) placement before versus after cardiac surgery is not well defined. METHODS: We reviewed data from all cardiac surgical patients who received perioperative IABP support at a veterans' hospital between April 1992 and April 2008. We compared outcomes between patients who received an IABP before surgery (BS, n = 36) and after surgery (AS, n = 28). RESULTS: The AS group had higher operative morbidity (71% vs 42%) and mortality (43% vs 14%) rates than the BS group (P < .02 for both). Furthermore, survival rates were lower in the AS group than in the BS group at 1 year (50% vs 83%) and 3 years (46% vs 80%) (log-rank test, P < .004). CONCLUSIONS: Patients who require IABP after cardiac surgery may have worse outcomes than patients who receive IABP support before surgery. In both groups, after an early peak in mortality, the midterm outcomes were characterized by a reassuring plateau in the survival rates.

Digoxin and clinical outcomes in systolic heart failure patients on contemporary background heart failure therapy.

Previous trials have shown that digoxin was beneficial in patients with heart failure (HF). However, these studies were conducted before the incorporation of beta blockers as standard therapy for patients with HF. The purpose of this study was to determine the effect of digoxin in patients with HF on a contemporary regimen of renin-angiotensin inhibition and beta blockade. In 347 almost exclusively men, data pertaining to the index hospitalization and occurrence of all-cause mortality or readmission for HF were collected. Cox proportional hazard modeling was used. Patients on digoxin therapy had a lower left ventricular (LV) ejection fraction (EF), higher prevalence of previous hospitalizations for HF and atrial fibrillation, and lower prevalence of hypertension. After adjustment for age, LVEF, history of HF hospitalizations, New York Heart Association class, presence of chronic renal insufficiency, presence of atrial fibrillation, and prescriptions for beta blockers and angiotensin converting enzyme inhibitors or angiotensin receptor blockers, HF hospitalizations (hazard ratio 1.08, 95% confidence interval [CI] 0.77 to 1.50, p = 0.66), total mortality (hazard ratio 1.03, 95% CI 0.78 to 1.35, p = 0.85), or the combined end point of HF hospitalization and total mortality (hazard ratio 1.11, 95% CI 0.81 to 1.53, p = 0.52) were not different in patients using digoxin compared with those not using digoxin. Clinical outcomes were not different in subgroups of patients with EF < or =25%, New York Heart Association class III or IV, atrial fibrillation, heart rate < or =60 beats/min, or patients on beta-blocker therapy. In conclusion, digoxin use was not associated with a decrease in HF hospitalizations or overall mortality rates in a cohort of hospitalized patients with HF with LV systolic dysfunction on contemporary background HF treatment including angiotensin-converting enzyme inhibitors and beta blockers.

The July effect and cardiac surgery: the effect of the beginning of the academic cycle on outcomes.

BACKGROUND: The effect of the time of the academic year on cardiac surgical outcomes is unknown. METHODS: Using prospectively collected data, we identified all (n = 1,673) cardiac surgical procedures performed at our institution between October 1997 and April 2007. Morbidity and mortality rates were compared between 2 periods of the academic year, one early (July 1-August 31, n = 242) and one later in the year (September 1-June 30, n = 1,431). A prediction model was constructed by using stepwise logistic regression modeling. RESULTS: Morbidity rates did not differ significantly between the early (12.8%) and later periods (15.4%) (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.54-1.28; P = 0.3). Additionally, there was no significant difference in operative mortality between the early (1.2%) and later periods (3.5%) (OR, 0.28; 95% CI, 0.07-1.19; P = 0.06). CONCLUSIONS: The early and later parts of the academic year were associated with similar risk-adjusted outcomes. Further studies are needed to determine whether our findings are applicable to other academic cardiac centers.

Does the use of bilateral internal mammary artery grafts impact survival of veterans undergoing coronary artery bypass surgery?

BACKGROUND: The impact of bilateral internal mammary artery (BIMA) versus single left internal mammary artery (LIMA) grafts on long-term survival in veterans after coronary artery bypass graft (CABG) surgery is unknown. METHODS: A review of prospectively collected data identified all patients (n = 784) who underwent primary isolated CABG surgery from December 1991 through December 1998. Grafting was performed with LIMA in 713 (90.9%) patients and with BIMA in 71 (9.1%) patients. We identified 66 propensity-matched patient pairs. RESULTS: The matched cohort was all male. The mean follow-up was 9.7 +/- 3.8 years. Comparing matched patients showed no significant survival benefit for the BIMA group versus the LIMA group at 5 years (89% versus 86%) and 10 years (73% versus 69%) (P = .99). Factors associated with decreased survival were advanced age, higher New York Heart Association heart failure class, and diabetes. CONCLUSIONS: Using BIMA grafting instead of LIMA grafting had no significant survival benefit for male veterans who underwent CABG surgery. Further study is needed to fully evaluate the role of BIMA grafting in this unique patient population.

Cardiac allograft vasculopathy: the Achilles' heel of long-term survival after cardiac transplantation.

Over the past 40 years, cardiac transplantation has evolved as the single best long-term option for eligible candidates with end-stage heart failure. Approximately 2000 transplants are performed annually in the United States, and with the institution of calcineurin-based immunotherapy, surveillance biopsies, and programmatic-based patient care, life expectancy at 1 and 12 years is 85% and 50%, respectively. Cardiac allograft vasculopathy (CAV) is the number one cause of death after the first year of transplantation. The incidence of CAV remains as high as 50% at 5 years, with life expectancy significantly abbreviated once it is recognized. Although current immunotherapy has reduced the likelihood of cellular rejection, it has not impacted CAV substantially. Better treatment of established risk factors and the advent of newer antiproliferative immunotherapy may hold promise in treating CAV. However, future therapies must address the multitude of mechanisms underlying CAV. This manuscript reviews the pathophysiology, clinical manifestations, screening, and diagnostic strategies for cardiac allograft vasculopathy while emphasizing current treatment paradigms designed to stave off or retard the progression of CAV.