Pergola Valeria, Mattesi Giulia, Cozza Elena, Pradegan Nicola, Tessari Chiara, Dellino Carlo Maria, Savo Maria Teresa, Amato Filippo, Cecere Annagrazia, Perazzolo Marra Martina, Tona Francesco, Guaricci Andrea Igoren, De Conti Giorgio, Gerosa Gino, Iliceto Sabino, Motta Raffaella
Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy.
Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy.
Diagnostics (Basel). 2023 Aug 31;13(17):2818. doi: 10.3390/diagnostics13172818.
Heart transplantation (HT) is the established treatment for end-stage heart failure, significantly enhancing patients' survival and quality of life. To ensure optimal outcomes, the routine monitoring of HT recipients is paramount. While existing guidelines offer guidance on a blend of invasive and non-invasive imaging techniques, certain aspects such as the timing of echocardiographic assessments and the role of echocardiography or cardiac magnetic resonance (CMR) as alternatives to serial endomyocardial biopsies (EMBs) for rejection monitoring are not specifically outlined in the guidelines. Furthermore, invasive coronary angiography (ICA) is still recommended as the gold-standard procedure, usually performed one year after surgery and every two years thereafter. This review focuses on recent advancements in non-invasive and contrast-saving imaging techniques that have been investigated for HT patients. The aim of the manuscript is to identify imaging modalities that may potentially replace or reduce the need for invasive procedures such as ICA and EMB, considering their respective advantages and disadvantages. We emphasize the transformative potential of non-invasive techniques in elevating patient care. Advanced echocardiography techniques, including strain imaging and tissue Doppler imaging, offer enhanced insights into cardiac function, while CMR, through its multi-parametric mapping techniques, such as T1 and T2 mapping, allows for the non-invasive assessment of inflammation and tissue characterization. Cardiac computed tomography (CCT), particularly with its ability to evaluate coronary artery disease and assess graft vasculopathy, emerges as an integral tool in the follow-up of HT patients. Recent studies have highlighted the potential of nuclear myocardial perfusion imaging, including myocardial blood flow quantification, as a non-invasive method for diagnosing and prognosticating CAV. These advanced imaging approaches hold promise in mitigating the need for invasive procedures like ICA and EMB when evaluating the benefits and limitations of each modality.
心脏移植（HT）是终末期心力衰竭的既定治疗方法，可显著提高患者的生存率和生活质量。为确保获得最佳治疗效果，对心脏移植受者进行常规监测至关重要。虽然现有指南对侵入性和非侵入性成像技术的综合应用提供了指导，但某些方面，如超声心动图评估的时机，以及超声心动图或心脏磁共振（CMR）作为连续心内膜心肌活检（EMB）替代方法用于排斥反应监测的作用，在指南中并未具体阐述。此外，侵入性冠状动脉造影（ICA）仍被推荐为金标准程序，通常在术后一年进行，此后每两年进行一次。本综述重点关注针对心脏移植患者研究的非侵入性和节省造影剂成像技术的最新进展。本文的目的是确定可能潜在替代或减少对ICA和EMB等侵入性程序需求的成像方式，同时考虑它们各自的优缺点。我们强调非侵入性技术在提升患者护理方面的变革潜力。先进的超声心动图技术，包括应变成像和组织多普勒成像，能更深入地洞察心脏功能，而CMR通过其多参数映射技术，如T1和T2映射，可对炎症和组织特征进行非侵入性评估。心脏计算机断层扫描（CCT），特别是其评估冠状动脉疾病和评估移植血管病变的能力，成为心脏移植患者随访中的重要工具。最近的研究强调了核素心肌灌注成像的潜力，包括心肌血流定量，作为诊断和预测冠状动脉移植物血管病变（CAV）的非侵入性方法。在评估每种成像方式的益处和局限性时，这些先进的成像方法有望减少对ICA和EMB等侵入性程序的需求。
