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Transplant allograft vasculopathy: Role of multimodality imaging in surveillance and diagnosis
Gregory A Payne1, Fadi G Hage1,2, Deepak Acharya3
1Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA.
Insights
Cardiac allograft vasculopathy (CAV) monitoring is evolving. Advanced noninvasive imaging offers a safer, comprehensive alternative to traditional angiography for assessing transplanted heart health and predicting outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a major long-term complication after heart transplantation, leading to graft failure and death.
- CAV is an inflammatory condition distinct from typical atherosclerosis.
- Current surveillance relies on invasive coronary angiography, which has limitations.
Purpose of the Study:
- To review advanced imaging modalities for CAV surveillance, diagnosis, and prognosis.
- To discuss coronary physiology in transplanted hearts.
- To highlight clinical implications for stress testing in CAV.
Main Methods:
- Review of key imaging techniques for CAV assessment.
- Discussion of coronary physiology and stress testing in heart transplant recipients.
- Focus on noninvasive methods for evaluating vascular lumen, wall characteristics, blood flow, and myocardial function.
Main Results:
- Technological advancements enable noninvasive assessment of vascular and myocardial parameters.
- New imaging techniques offer a low-risk, expeditious approach compared to angiography.
- These methods allow comprehensive evaluation of CAV and transplanted heart status.
Conclusions:
- Noninvasive imaging modalities are becoming crucial for CAV management.
- Advanced imaging provides detailed insights into CAV and transplanted heart physiology.
- These techniques have significant clinical implications for patient care and prognosis.
Abstract:
Cardiac allograft vasculopathy (CAV) is a challenging long-term complication of cardiac transplantation and remains a leading long-term cause of graft failure, re-transplantation, and death. CAV is an inflammatory vasculopathy distinct from traditional atherosclerotic coronary artery disease. Historically, the surveillance and diagnosis of CAV has been dependent on serial invasive coronary angiography with intravascular imaging. Although commonly practiced, angiography is not without significant limitations. Technological advances have provided sophisticated imaging techniques for CAV assessment. It is now possible to assess the vascular lumen, vessel wall characteristics, absolute blood flow, perfusion reserve, myocardial contractile function, and myocardial metabolism and injury in a noninvasive, expeditious manner with little risk. The current article will review key imaging modalities for the surveillance, diagnosis, and prognosis of CAV and discuss coronary physiology of transplanted hearts with emphasis on the clinical implications for provocative and vasodilator stress testing.
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