Positron Emission Tomography in the Diagnosis and Management of Cardiac Allograft Vasculopathy

This review aims to evaluate the current diagnostic standards for cardiac allograft vasculopathy (CAV) in heart transplant recipients, with a focus on the role of positron emission tomography (PET) myocardial perfusion imaging (MPI). The review addresses the efficacy of PET as a non-invasive alternative to invasive coronary angiography (ICA) and discusses recent guidelines and advancements in the detection and management of CAV. Recent research underscores the potential role of PET imaging in detecting CAV, particularly by assessing myocardial blood flow (MBF) and myocardial flow reserve (MFR). PET has emerged as a highly effective tool, offering potential advantages in diagnostic accuracy, cost-effectiveness, and reduced radiation exposure compared to ICA. The 2023 International Society for Heart and Lung Transplantation guidelines list PET MPI as a Class IIa indication for non-invasive CAV screening, highlighting its superior prognostic value. Studies demonstrate that PET-derived MBF and MFR correlate well with invasive measures and predict adverse outcomes, emphasizing the role of PET MPI in the early detection and management of CAV. Additionally, PET MPI can potentially reduce the need for frequent invasive procedures, thereby lowering healthcare costs. PET MPI significantly enhances the detection and prognostication of CAV in heart transplant recipients, providing a non-invasive, accurate, and cost-effective alternative to ICA. Integrating PET into routine surveillance protocols can improve early diagnosis and management of CAV, ultimately enhancing patient outcomes. Large multicenter studies are needed to optimize surveillance strategies and to further validate the role of PET in CAV detection and management.