Advances in Cardiovascular Imaging Role of Noninvasive Imaging in the Diagnosis of Cardiac

Cardiac allograft vasculopathy (CAV) is common, with aprevalence of 52 % at 10 years after transplantation, and represents a leading cause of death beyond the first year, responsible for approximately 15 % of deaths annually.1 It is characterized by diffuse and concentric intimal proliferation, typically involving the intramural as well as epicardial coronary arteries. Its diagnosis is difficult to establish clini-cally because of denervation of the transplanted heart. Con-sequently, it presents late with silent myocardial infarction, progressive heart failure, or arrhythmic sudden death.2 Screening is therefore required for its early detection. Although coronary intravascular ultrasound (IVUS) is considered the gold-standard technique for detecting the anatomic features of CAV (Table 1), its broad clinical use in this context is limited by cost and lack of widespread expertise, and its evaluation is limited to epicardial vessels.