Imaging recommendation · Cardiac

Heart transplant surveillance / suspected rejection or vasculopathy

Q: What's the alternative imaging for heart transplant surveillance / suspected rejection or vasculopathy when non-invasive rejection assessment?

MRI — Cardiac MRI (T1/T2 mapping) (iv contrast).

Recommended: Endomyocardial biopsy + Coronary CTA (or surveillance angiography) + Cardiac MRI is the preferred imaging study for heart transplant surveillance / suspected rejection or vasculopathy. EMB for rejection screening; coronary surveillance for cardiac allograft vasculopathy (CAV).

Recommended study

Endomyocardial biopsy + Coronary CTA (or surveillance angiography) + Cardiac MRI

MRI IV contrast Preferred Cardiac Outpatient Reviewed 2026-05

EMB for rejection screening; coronary surveillance for cardiac allograft vasculopathy (CAV).

If the default doesn't apply

Non-invasive rejection assessment

MRI Cardiac MRI (T1/T2 mapping) IV contrast

Watch-outs

Cardiac allograft vasculopathy (CAV)

Diffuse intimal hyperplasia — first sign may be subtle wall thickening; IVUS / OCT more sensitive than angiography.

Post-transplant lymphoproliferative disorder (PTLD)

Image with PET/CT if suspected.

Pearls

ISHLT grading for cellular rejection (1R-3R) and AMR.
CAV surveillance annual coronary angiography for first 5 years.
Late complications: malignancy, CKD from CNI.