title: Transplant allograft vasculopathy: Role of multimodality imaging in surveillance and diagnosis.
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.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Payne
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA.|Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
authors.forename: Fadi G
authors.initials: FG
authors.lastname: Hage
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Tinsley Harrison Tower, Room 321, Birmingham, AL, 35294-006, USA. dacharya@uab.edu.
authors.forename: Deepak
authors.initials: D
authors.lastname: Acharya
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology*; D019317:Evidence-Based Medicine; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D016896:Treatment Outcome; D057832:Watchful Waiting / Q000379:methods
keywords: Cardiac allograft vasculopathy; coronary flow reserve; multimodality imaging; myocardial perfusion imaging