Payne Gregory A, Hage Fadi G, Acharya Deepak
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.
J Nucl Cardiol. 2016 Aug;23(4):713-27. doi: 10.1007/s12350-015-0373-3. Epub 2015 Dec 28.
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.
心脏移植血管病变（CAV）是心脏移植具有挑战性的长期并发症，仍是移植物衰竭、再次移植和死亡的主要长期原因。CAV是一种与传统动脉粥样硬化性冠状动脉疾病不同的炎症性血管病变。从历史上看，CAV的监测和诊断依赖于连续的有创冠状动脉造影及血管内成像。尽管血管造影是常用方法，但并非没有显著局限性。技术进步为CAV评估提供了先进的成像技术。现在可以以无创、快速且风险极小的方式评估血管腔、血管壁特征、绝对血流、灌注储备、心肌收缩功能以及心肌代谢和损伤。本文将综述CAV监测、诊断和预后的关键成像方式，并讨论移植心脏的冠状动脉生理学，重点是激发试验和血管扩张剂负荷试验的临床意义。
