New imaging techniques in the monitoring of cardiac transplants

Purpose of review Diagnosis of cardiac rejection and transplant coronary artery disease is a clinical challenge in the surveillance of heart allograft recipients. Endomyocardial biopsy and conventional coronary angiography are today both considered the 'gold standard'. Here, we focus on new imaging techniques that could be noninvasive alternate modalities in this settings. Recent findings Over the past 5 years, magnetic resonance imaging and pulsed-wave Doppler tissue imaging have come to the forefront in heart transplant surveillance. Several studies have reported the possibility of detecting rejection using these techniques, with promising results in experimental magnetic resonance imaging -Doppler tissue imaging may be useful in clinical practice, as endomyocardial biopsy may reasonably be avoided if the examination of the allograft with magnetic resonance imaging -Doppler tissue imaging is strictly normal. New-generation multislice computed tomography has recently allowed reliable visualization of the 1 coronary artery tree, making possible noninvasive diagnosis of coronary artery vasculopathy. Summary The use of new diagnostic modalities has to be based on their complementarities as none of them is sufficiently reliable, when used separately, compared with invasive techniques. The Doppler tissue imaging -magnetic resonance imaging -computed tomography combination seems to be a reliable strategy for the surveillance of adult and child transplant patients.