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Diagnosis and management of cardiac allograft vasculopathy
  1. Juan M Ortega-Legaspi1,
  2. Paco E Bravo1,2
  1. 1 Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2 Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Juan M Ortega-Legaspi, Medicine/Cardiovascular Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Juan.OrtegaLegaspi{at}


One of the main causes of death beyond the first year after heart transplantation is cardiac allograft vasculopathy (CAV). This review summarises the current understanding of its complex pathophysiology, detection and treatment, including the available data on non-invasive imaging modalities used for screening and diagnosis. A better understanding of this entity is crucial to improving the long-term outcomes of the growing population of patients with a heart transplant.

  • heart transplantation
  • cardiac imaging techniques
  • echocardiography
  • positron-emission tomography
  • magnetic resonance imaging

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  • Contributors JMOL wrote the following sections: abstract, introduction, pathophysiology, definition and epidemiology, treatment, revascularisation and retransplant. PB wrote the following sections: clinical manifestations, diagnosis and prognostic markers, non-invasive evaluation of cardiac allograft vasculopathy, dobutamine stress echocardiography, myocardial perfusion imaging with nuclear techniques, CTA, cMRI and summary.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note Additional references can be found in online supplemental file 1.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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