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Transplant allograft vasculopathy: Role of multimodality imaging in surveillance and diagnosis

  • CME Article Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

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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Abbreviations

CAD:

Coronary artery disease

CAV:

Cardiac allograft vasculopathy

PCI:

Percutaneous coronary intervention

CABG:

Coronary artery bypass grafting

SPECT:

Single-photon emission computed tomography myocardial perfusion imaging

PET:

Positron emission tomography

CFR:

Coronary flow reserve

CAG:

Coronary angiography

IVUS:

Intravascular ultrasound

OCT:

Optical coherence tomography

MBG:

Myocardial blush grade

2DE:

Two-dimensional echocardiography

DSE:

Dobutamine stress echocardiography

CMR:

Cardiac magnetic resonance imaging

PPV:

Positive predictive value

NPV:

Negative predictive value

VEGF:

Vascular endothelial growth factor

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Acknowledgments

The authors would like to acknowledge Dr. Wael Jaber and Dr. Paul Cremer from Cleveland Clinic Hospital for contributing some of the presented images.

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The authors have indicated that they have no financial conflict of interest.

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Authors and Affiliations

  1. Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA

    Gregory A. Payne MD, PhD, Fadi G. Hage MD & Deepak Acharya MD, MSPH

  2. Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Fadi G. Hage MD

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  1. Gregory A. Payne MD, PhD
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Correspondence to Deepak Acharya MD, MSPH.

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Payne, G.A., Hage, F.G. & Acharya, D. Transplant allograft vasculopathy: Role of multimodality imaging in surveillance and diagnosis. J. Nucl. Cardiol. 23, 713–727 (2016). https://doi.org/10.1007/s12350-015-0373-3

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