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Imaging Coronary Allograft Vasculopathy with Cardiac PET and Cardiac MRI


Purpose of Review

Coronary allograft vasculopathy (CAV) is a leading cause of morbidity and mortality in heart transplant patients. It presents a diagnostic challenge as early CAV is often clinically silent, and it affects both epicardial coronary arteries and microvasculature. This review outlines the role of cardiac positron emission tomography (PET) and cardiac magnetic resonance imaging (CMR) in the diagnosis and prognosis of CAV.

Recent Findings

Relative myocardial perfusion imaging (MPI) and quantitative myocardial blood flow using cardiac PET are useful in the diagnosis and prognosis of CAV. Late gadolinium enhancement (LGE) and quantitative measures including myocardial perfusion reserve and mean diastolic rate using CMR are useful in the diagnosis and prognosis of CAV.


Cardiac PET is now established as a non-invasive imaging modality for screening and monitoring for CAV, and CMR has demonstrated promise in this application. Further investigation of these modalities is needed with larger, multicenter studies that follow patients serially to demonstrate the clinical implications of using these modalities to detect early CAV and alter therapies to improve patient outcomes.

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      Correspondence to Chaitanya Madamanchi.

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      Conflict of Interest

      Dr. Murthy owns stock in General Electric and Cardinal Health. Dr. Murthy has served as an advisor to and owns stock options in Ionetix. Dr. Murthy has received speaking honoraria and research grants from Siemens Medical Imaging. Dr Murthy receives non-financial research support from INVIA Medical Imaging. He has received expert witness payments on behalf of Jubilant DraxImage and a speaking honorarium from 2Quart Medical. The other authors declare that they have no conflict of interest.

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      Madamanchi, C., Konerman, M.C. & Murthy, V.L. Imaging Coronary Allograft Vasculopathy with Cardiac PET and Cardiac MRI. Curr Cardiol Rep 23, 175 (2021).

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      • Coronary allograft vasculopathy
      • Positron emission tomography
      • Magnetic resonance imaging