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Invasive Coronary Imaging Assessment for Cardiac Allograft Vasculopathy: State-of-the-Art Review
Negeen Shahandeh1, Kuninobu Kashiyama2, Yasuhiro Honda2
1Division of Cardiology, University of California Los Angeles, Los Angeles, California.
Insights
Cardiac allograft vasculopathy (CAV) is a major threat after heart transplants. This review examines invasive imaging tools like coronary angiography and newer options to detect CAV earlier and improve patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Heart transplantation is a life-saving treatment for end-stage heart failure.
- While survival has improved, cardiac allograft vasculopathy (CAV) remains a significant cause of death and illness in heart transplant recipients.
- Current screening methods like coronary angiography have limitations in detecting early or widespread CAV.
Purpose of the Study:
- To review and compare invasive imaging modalities for cardiac allograft vasculopathy (CAV) surveillance in heart transplant recipients.
- To highlight the advantages and limitations of each imaging platform in detecting early CAV.
- To inform the development of more sensitive diagnostic tools for improved patient outcomes.
Main Methods:
- Review of current literature on invasive imaging techniques for CAV surveillance.
- Analysis of coronary angiography, intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy.
- Discussion of the data supporting the use of these modalities in the context of CAV.
Main Results:
- Coronary angiography, while standard, has limited sensitivity for early and diffuse CAV.
- Intravascular ultrasound offers more detailed vessel wall information.
- Emerging technologies like optical coherence tomography and near-infrared spectroscopy show promise for enhanced early detection.
Conclusions:
- Improved diagnostic tools are crucial for timely CAV detection and management in heart transplant patients.
- Advanced imaging modalities offer potential advantages over traditional coronary angiography for CAV surveillance.
- Further research is needed to fully establish the role of newer imaging technologies in optimizing heart transplant outcomes.
Abstract:
Heart transplantation is the standard of care treatment for end-stage heart failure. Therapeutic advances including enhanced immunosuppression and aggressive infectious prophylaxis have led to increased life-expectancy following transplantation; however, cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality. Although coronary angiography is the current guideline-recommended diagnostic modality for invasive CAV screening, it is limited in its ability to detect early and/or diffuse disease. Efforts to improve outcomes for heart transplant recipients with CAV have focused on developing diagnostic tools with greater sensitivity to capture early CAV in order to better understand the pathobiology and implement treatment to slow disease progression sooner after transplant. The contemporary invasive imaging armamentarium for CAV surveillance includes coronary angiography, intravascular ultrasound, and newer technologies including optical coherence tomography and near-infrared spectroscopy. The present review outlines the use of and data in support of these imaging platforms in the CAV arena and highlights the potential advantages and limitations of each of these modalities.
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