Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Curr Cardiol Rep. 2021 Oct 16;23(12):175. doi: 10.1007/s11886-021-01606-z.
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.
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.
冠状动脉移植血管病（CAV）是心脏移植患者发病率和死亡率的主要原因。由于早期 CAV 通常无临床症状，并且会影响心外膜冠状动脉和微血管，因此其诊断具有挑战性。本文综述了心脏正电子发射断层扫描（PET）和心脏磁共振成像（CMR）在 CAV 的诊断和预后中的作用。
相对心肌灌注成像（MPI）和心脏 PET 定量心肌血流在 CAV 的诊断和预后中有一定作用。心脏磁共振的钆延迟增强（LGE）和定量指标，包括心肌灌注储备和平均舒张率，在 CAV 的诊断和预后中有一定作用。心脏 PET 现已成为 CAV 筛查和监测的一种非侵入性成像方式，CMR 在该应用中也显示出一定的前景。需要进一步研究这些方法，开展更大规模的多中心研究，对患者进行连续随访，以证明使用这些方法检测早期 CAV 并改变治疗方法以改善患者预后的临床意义。
