Cardiac Allograft Vasculopathy: Challenges and Advances in Invasive and Non-Invasive Diagnostic Modalities

Moaz A. Kamel, Isabel G. Scalia, Amro T. Badr, Nima Baba Ali, Juan M. Farina, Milagros Pereyra, Mohammed Tiseer Abbas, Ahmed K. Mahmoud, Robert L. Scott, David E. Steidley, Julie L. Rosenthal, Lisa M. Lemond, Kristen A. Sell-Dottin, Brian W. Hardaway, Timothy Barry, Ming Yang, Chieh Ju Chao, Clinton E. Jokerst, Chadi Ayoub, Reza Arsanjani

Research output: Contribution to journalReview articlepeer-review


Cardiac allograft vasculopathy (CAV) is a distinct form of coronary artery disease that represents a major cause of death beyond the first year after heart transplantation. The pathophysiology of CAV is still not completely elucidated; it involves progressive circumferential wall thickening of both the epicardial and intramyocardial coronary arteries. Coronary angiography is still considered the gold-standard test for the diagnosis of CAV, and intravascular ultrasound (IVUS) can detect early intimal thickening with improved sensitivity. However, these tests are invasive and are unable to visualize and evaluate coronary microcirculation. Increasing evidence for non-invasive surveillance techniques assessing both epicardial and microvascular components of CAV may help improve early detection. These include computed tomography coronary angiography (CTCA), single-photon emission computed tomography (SPECT), positron emission tomography (PET), and vasodilator stress myocardial contrast echocardiography perfusion imaging. This review summarizes the current state of diagnostic modalities and their utility and prognostic value for CAV and also evaluates emerging tools that may improve the early detection of this complex disease.

Original languageEnglish (US)
Article number95
JournalJournal of Cardiovascular Development and Disease
Issue number3
StatePublished - Mar 2024


  • angiography
  • cardiac allograft vasculopathy
  • echocardiography
  • nuclear imaging

ASJC Scopus subject areas

  • General Pharmacology, Toxicology and Pharmaceutics
  • Pharmacology (medical)


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