New perspectives in the diagnosis of cardiac allograft vasculopathy: the CT-scan role in the follow-up of heart transplanted patients

Coronary allograft vasculopathy (CAV) limits long-term survival after heart transplantation, it is documented widely in scientific literature with original articles and reviews. The screening for CAV is generally performed on an annual or biannual basis. It is usually detected by conventional coronary angiography (CCA) but in the last ten years, Coronary Computed Tomography Angiography (CCTA) has spreading more in more in the study of early detection of CAV due to evolution of technologies. Technological advances such as 64-slice dual-source CCTA or 128-slice dual-source CCTA might justify re-evaluation of the current recommendation in the detection of CAV. Inspired by the high quality intravascular CAV detection (IVUS and OCT), I considered the CCTA as new diagnostical procedure with low-technical risk and high technologies and I developed my PhD issue in order to have the following endpoints: improving heart transplant recipient survival and decreasing/controlling the CAV incidence by rapid and early treatment. I conjectured: i) Which would be the new perspectives in CAV diagnostic imaging? ii) Considering the CCTA technological evolution, how could be the comparison with CCA? iii) How is the comparison with other recommended intravascular diagnostic procedures like IVUS? iv) Could I create a prognostic score to calculate indirectly the risk of CAV in heart transplanted patients in order to improve its management?