Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse form of vasculopathy affecting almost 50% of patients after 10 years from heart transplant and represents the most common cause of long-term cardiovascular mortality among heart transplant recipients. The gold standard diagnostic technique is still invasive coronary angiography, which however holds potential for complications, especially contrast-related kidney injury and procedure-related vascular lesions. Non-invasive and contrast-sparing imaging techniques have been advocated and investigated over the past decades, in order to identify those that could replace coronary angiography or at least reach comparable accuracy in CAV detection. In addition, they could help the clinician in defining optimal timing for invasive testing. This review attempts to examine the currently available non-invasive imaging techniques that may be used in the follow-up of heart transplant patients, spanning from echocardiography to nuclear imaging, cardiac magnetic resonance and cardiac computed tomography angiography, weighting their advantages and disadvantages.

心脏同种异体移植血管病变 (CAV) 是一种闭塞性和弥漫性血管病变，在心脏移植 10 年后影响近 50% 的患者，是心脏移植受者长期心血管死亡的最常见原因。金标准诊断技术仍然是侵入性冠状动脉造影，但它具有潜在的并发症，特别是与造影剂相关的肾损伤和与手术相关的血管病变。在过去的几十年中，人们提倡和研究了非侵入性和保留对比的成像技术，以识别那些可以替代冠状动脉造影或至少在 CAV 检测中达到相当准确度的技术。此外，它们可以帮助临床医生确定侵入性检测的最佳时机。