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The Role of Multimodality Cardiac Imaging in the Transplanted Heart

Department of Cardiology, Section of Heart Failure and Heart Transplantation, and Cardiovascular Imaging Institute, Methodist DeBakey Heart and Vascular Center, Houston, Texas

^_* Reprint requests and correspondence: Dr. Jerry D. Estep, Methodist DeBakey Heart and Vascular Center, Cardiology, Smith Tower, 6550 Fannin Street, Suite 1901, Houston, Texas 77030 (Email: jestep{at}tmhs.org).

Heart transplantation (HT) is an established life-saving treatment option for patients with end-stage heart failure. Despite many advances in the field, the development of acute cellular rejection (ACR) and cardiac allograft vasculopathy (CAV) represent significant causes of 1- and 5-year morbidity and mortality, respectively. The search for noninvasive techniques to assess cardiac allograft function and detect treatable ACR and CAV remains a priority objective for heart transplant professionals. In this review we will: 1) highlight the clinical significance of ACR and CAV in adult cardiac transplant recipients and 2) discuss how different noninvasive imaging modalities (echocardiography, cardiac computed tomography, myocardial perfusion imaging, and cardiac magnetic resonance) have been used in the evaluation of these clinical challenges after HT.

Key Words: heart transplant • acute cellular rejection • vasculopathy • cardiac imaging

Abbreviations and Acronyms   ACR = acute cellular rejection   CAV = cardiac allograft vasculopathy   CMR = cardiac magnetic resonance   DSE = dobutamine stress echocardiography   EMB = endomyocardial biopsy   HT = heart transplantation   IVUS = intravascular ultrasound   LV = left ventricular   MACE = major adverse cardiac events   MDCT = multidetector computed tomography   SPECT-MPI = single-photon emission computed tomography-myocardial perfusion imaging   TDI = tissue Doppler imaging

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