Cardiac Allograft Vasculopathy: Challenges and Advances in Invasive and Non-Invasive Diagnostic Modalities

Area of Science:

• Cardiology
• Transplantation Medicine
• Diagnostic Imaging

Background:

• Cardiac allograft vasculopathy (CAV) is a major cause of mortality post-heart transplant, characterized by coronary artery disease.
• Its pathophysiology involves progressive thickening of epicardial and intramyocardial coronary arteries, but remains incompletely understood.
• Current diagnostic methods like coronary angiography and intravascular ultrasound (IVUS) are invasive and limited in assessing microcirculation.

Purpose of the Study:

• To review the current diagnostic modalities for CAV.
• To evaluate the utility and prognostic value of existing tests.
• To assess emerging non-invasive techniques for early CAV detection, encompassing both epicardial and microvascular components.

Main Methods:

• Review of current literature on diagnostic techniques for CAV.
• Analysis of invasive methods: coronary angiography and IVUS.
• Evaluation of non-invasive imaging modalities: CTCA, SPECT, PET, and myocardial contrast echocardiography.

Main Results:

• Coronary angiography is the gold standard, while IVUS offers improved sensitivity for intimal thickening.
• Invasive methods cannot adequately assess coronary microcirculation.
• Emerging non-invasive techniques show promise for comprehensive CAV assessment.

Conclusions:

• There is a need for improved surveillance techniques for CAV.
• Non-invasive methods like CTCA, SPECT, PET, and echocardiography are crucial for assessing both epicardial and microvascular disease.
• Early detection through advanced imaging may improve outcomes for heart transplant recipients.