Ajluni Steven C, Mously Haytham, Chami Tarek, Hajjari Jamal, Stout Amber, Zacharias Michael, ElAmm Chantal, Wilson David, Janus Scott E, Al-Kindi Sadeer G
Department of Medicine, University Hospitals, Cleveland, OH.
Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH.
Curr Probl Cardiol. 2022 Aug;47(8):101103. doi: 10.1016/j.cpcardiol.2022.101103. Epub 2022 Jan 10.
Cardiac allograft vasculopathy (CAV) is the leading cause of long-term graft dysfunction in patients with heart transplantation and is linked with significant morbidity and mortality. Currently, the gold standard for diagnosing CAV is coronary imaging with intravascular ultrasound during traditional invasive coronary angiography. Invasive imaging, however, carries increased procedural risk and expense to patients in addition to requiring an experienced interventionalist. With the improvements in non-invasive cardiac imaging modalities such as transthoracic echocardiography, computed tomography, magnetic resonance imaging and positron emission tomography, an alternative non-invasive imaging approach for the early detection of CAV may be feasible. In this systematic review, we explored the literature to investigate the utility of non-invasive imaging in diagnosis of CAV in >3000 patients across 49 studies. We also discuss the strengths and weaknesses for each imaging modality. Overall, all 4 imaging modalities show good to excellent accuracy for identifying CAV with significant variations across studies. Majority of the studies compared non-invasive imaging with invasive coronary angiography without intravascular imaging. In summary, non-invasive imaging modalities offer an alternative approach to invasive coronary imaging for CAV. Future studies should investigate longitudinal non-invasive protocols in low-risk patients after heart transplantation.
心脏移植血管病变（CAV）是心脏移植患者长期移植物功能障碍的主要原因，与显著的发病率和死亡率相关。目前，诊断CAV的金标准是在传统的有创冠状动脉造影期间使用血管内超声进行冠状动脉成像。然而，有创成像除了需要经验丰富的介入专家外，还会增加患者的手术风险和费用。随着经胸超声心动图、计算机断层扫描、磁共振成像和正电子发射断层扫描等无创心脏成像技术的改进，一种用于早期检测CAV的替代无创成像方法可能是可行的。在这项系统评价中，我们检索了文献，以调查49项研究中3000多名患者的无创成像在诊断CAV中的效用。我们还讨论了每种成像方式的优缺点。总体而言，所有4种成像方式在识别CAV方面都显示出良好至优异的准确性，各研究之间存在显著差异。大多数研究将无创成像与没有血管内成像的有创冠状动脉造影进行了比较。总之，无创成像方式为CAV的有创冠状动脉成像提供了一种替代方法。未来的研究应调查心脏移植后低风险患者的纵向无创方案。
