Evaluation of cardiac allograft vasculopathy by positron emission tomography

Fehér, Attila; Sinusas, Albert J.

doi:10.1007/s12350-020-02438-0

Cited by 6 publications

(6 citation statements)

References 64 publications

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“…Abnormal microvascular function has been associated with overt CAV or its future development, plaque progression in the allograft epicardial coronary arteries, 16 and poor outcomes. 6 , 17 The main advantage of vasodilator stress MCE over PET imaging, which also quantifies myocardial blood flow, is better spatial resolution, lower cost, and avoidance of radiation exposure to the patient and health professionals, which is notable given malignancy is the second highest cause of mortality in heart transplant recipients after CAV. 10 Additionally, PET's limited spatial resolution can affect our ability to differentiate large, epicardial perfusion defects from diffuse microvascular disease as well as to identify, patchy, endocardial perfusion defects.…”

Section: Discussionmentioning

confidence: 99%

“… 3–5 While microvascular dysfunction in CAV is not routinely tested, the 2021 ISHLT guidelines give a Class IIa, (LOE B) recommendation to evaluating intracoronary flow at the time of coronary angiography to detect small vessel CAD 1 . Positron emission tomography (PET) perfusion imaging can non‐invasively quantify myocardial blood flow and coronary vascular resistance, however, is also associated with radiation exposure 6 . The 2021 ISHLT guidelines provide a class IIa, (LOE B) recommendation for using PET for detection of CAV and a Class II (LOE C) recommendation for cardiac magnetic resonance myocardial perfusion reserve and delayed gadolinium enhancement assessment.…”

Section: Introductionmentioning

confidence: 99%

“… 1 Positron emission tomography (PET) perfusion imaging can non‐invasively quantify myocardial blood flow and coronary vascular resistance, however, is also associated with radiation exposure. 6 The 2021 ISHLT guidelines provide a class IIa, (LOE B) recommendation for using PET for detection of CAV and a Class II (LOE C) recommendation for cardiac magnetic resonance myocardial perfusion reserve and delayed gadolinium enhancement assessment.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac allograft vasculopathy diagnosed by vasodilator myocardial contrast echocardiography perfusion imaging

et al. 2023

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Cardiac allograft vasculopathy (CAV) remains a common long‐term complication of cardiac transplantation. While invasive coronary angiography is considered the gold standard, it is also invasive and lacks sensitivity to detect early, distal CAV. Although vasodilator stress myocardial contrast echocardiography perfusion imaging (MCE) is used in the detection of microvascular disease in non‐transplant patients, there is little data guiding its use in transplant recipients. Herein is a case series of four heart transplant recipients that had vasodilator stress MCE performed in addition to invasive coronary angiography for CAV surveillance. MCE at rest and after regadenason was performed using a continuous infusion of lipid‐shelled microbubbles. We describe a case of normal microvascular function, diffuse microvascular dysfunction, patchy sub‐endocardial perfusion defects and a focal sub‐endocardial perfusion defect. Cardiac allograft vasculopathy can be heralded by several different perfusion patterns on MCE in patients after orthotopic heart transplant. The varying prognoses and potential interventions for these different patterns require further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac allograft vasculopathy diagnosed by vasodilator myocardial contrast echocardiography perfusion imaging

et al. 2023

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“…However, it suffers from highly variable sensitivity and specificity from center to center as compared to invasive testing [28,29]. Rubidium-82 positron emission tomography has emerged as one possible alternative to DSE, with multiple studies over the past year validating its use for early detection of clinically significant CAV (ISHLT grade 2-3) [30][31][32][33][34][35][36]. Coronary computed tomography angiography (CCTA) represents another potential noninvasive screening tool, reported to exhibit high sensitivity and specificity for CAV detection compared to invasive angiography [37].…”

Section: Cardiac Allograft Vasculopathy Detectionmentioning

confidence: 99%

Noninvasive methods to reduce cardiac complications postheart transplant

Zhou

Wolfson

Vaidya

2021

Current Opinion in Organ Transplantation

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Purpose of reviewLong-term success of heart transplantation is limited by allograft rejection and cardiac allograft vasculopathy (CAV). Classic management has relied on frequent invasive testing to screen for early features of rejection and CAV to allow for early treatment. In this review, we discuss new developments in the screening and prevention of allograft rejection and CAV. Recent findingsNewer noninvasive screening techniques show excellent sensitivity and specificity for the detection of clinically significant rejection. New biomarkers and treatment targets continue to be identified and await further studies regarding their utility in preventing allograft vasculopathy. SummaryNoninvasive imaging and biomarker testing continue to show promise as alternatives to invasive testing for allograft rejection. Continued validation of their effectiveness may lead to new surveillance protocols with reduced frequency of invasive testing. Furthermore, these noninvasive methods will allow for more personalized strategies to reduce the complications of long-term immunosuppression whereas continuing the decline in the overall rate of allograft rejection.

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“…6 (5) Noninvasive diagnostic and prognostic assessment of cardiac allograft vasculopathy (CAV) following heart transplantation (HTx). [7][8][9][10][11][12] Cardiac PET with assessment of MBFR seems to be ideally suited for the evaluation of CAV. CAV is a diffuse process affecting the epicardial coronary arteries and the microvasculature resulting in reduced vasodilatory capacity.…”

mentioning

confidence: 99%

Noninvasive surveillance for cardiac allograft vasculopathy following heart transplantation: One of several emerging clinical applications for cardiac positron emission tomography with assessment of myocardial blood flow reserve

Calnon

2022

Journal of Nuclear Cardiology

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Evaluation of cardiac allograft vasculopathy by positron emission tomography

Cited by 6 publications

References 64 publications

Cardiac allograft vasculopathy diagnosed by vasodilator myocardial contrast echocardiography perfusion imaging

Cardiac allograft vasculopathy diagnosed by vasodilator myocardial contrast echocardiography perfusion imaging

Noninvasive methods to reduce cardiac complications postheart transplant

Noninvasive surveillance for cardiac allograft vasculopathy following heart transplantation: One of several emerging clinical applications for cardiac positron emission tomography with assessment of myocardial blood flow reserve

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