{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T18:42:18Z","timestamp":1772131338220,"version":"3.50.1"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"vor","delay-in-days":914,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Cardiac allograft vasculopathy (CAV) remains a common long-term complication of cardiac transplantation. While invasive coronary angiography is considered the gold standard, it is also invasive and lacks sensitivity to detect early, distal CAV. Although vasodilator stress myocardial contrast echocardiography perfusion imaging (MCE) is used in the detection of microvascular disease in non-transplant patients, there is little data guiding its use in transplant recipients. Herein is a case series of four heart transplant recipients that had vasodilator stress MCE performed in addition to invasive coronary angiography for CAV surveillance. MCE at rest and after regadenason was performed using a continuous infusion of lipid-shelled microbubbles. We describe a case of normal microvascular function, diffuse microvascular dysfunction, patchy sub-endocardial perfusion defects and a focal sub-endocardial perfusion defect. Cardiac allograft vasculopathy can be heralded by several different perfusion patterns on MCE in patients after orthotopic heart transplant. The varying prognoses and potential interventions for these different patterns require further investigation.<\/jats:p>","DOI":"10.1002\/ehf2.14464","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T03:38:35Z","timestamp":1688441915000},"page":"3184-3189","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cardiac Allograft Vasculopathy Diagnosed by Vasodilator Myocardial Contrast Echocardiography Perfusion Imaging"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4178-8431","authenticated-orcid":false,"given":"Pooja","family":"Prasad","sequence":"first","affiliation":[{"name":"Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raj","family":"Nagappan","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian P.","family":"Davidson","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Wei","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Hodovan","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R.","family":"Lindner","sequence":"additional","affiliation":[{"name":"University of Virginia Health System , Charlottesville, VA ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Steiner","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University , Portland, OR ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,4]]},"reference":[{"key":"2026012113213650300_ehf214464-bib-0001","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.healun.2022.10.015","article-title":"The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients","volume":"42","author":"Velleca","year":"2023","journal-title":"J Heart Lung Transplant"},{"key":"2026012113213650300_ehf214464-bib-0002","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1161\/CIRCULATIONAHA.107.711911","article-title":"Cardiac allograft vasculopathy: recent developments","volume":"117","author":"Schmauss","year":"2008","journal-title":"Circulation"},{"key":"2026012113213650300_ehf214464-bib-0003","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1016\/j.jacc.2022.08.753","article-title":"The panvascular interplay in pathophysiology and prognosis of cardiac allograft vasculopathy","volume":"80","author":"Mehra","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026012113213650300_ehf214464-bib-0004","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1016\/j.jacc.2018.09.042","article-title":"Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC state-of-the-art review","volume":"72","author":"Taqueti","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026012113213650300_ehf214464-bib-0005","first-page":"2624","article-title":"Cardiac allograft vasculopathy: current review and future research directions","volume":"117","author":"Pober","year":"2021","journal-title":"Cardiovasc Res"},{"key":"2026012113213650300_ehf214464-bib-0006","doi-asserted-by":"crossref","first-page":"2616","DOI":"10.1007\/s12350-020-02438-0","article-title":"Evaluation of cardiac allograft vasculopathy by positron emission tomography","volume":"28","author":"Feher","year":"2021","journal-title":"J Nucl Cardiol"},{"key":"2026012113213650300_ehf214464-bib-0007","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.echo.2017.11.013","article-title":"Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography guidelines update","volume":"31","author":"Porter","year":"2018","journal-title":"J Am Soc Echocardiogr"},{"key":"2026012113213650300_ehf214464-bib-0008","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1161\/01.CIR.0000132613.53542.E9","article-title":"Myocardial contrast echocardiography","volume":"109","author":"Lepper","year":"2004","journal-title":"Circulation"},{"key":"2026012113213650300_ehf214464-bib-0009","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.jacc.2007.09.051","article-title":"The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling: results of the multicenter AMICI study","volume":"51","author":"Galiuto","year":"2008","journal-title":"J Am Coll Cardiol"},{"key":"2026012113213650300_ehf214464-bib-0010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2019.07.001","article-title":"Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography","volume":"33","author":"Pellikka","year":"2020","journal-title":"J Am Soc Echocardiogr"},{"key":"2026012113213650300_ehf214464-bib-0011","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.healun.2010.05.017","article-title":"International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010","volume":"7","author":"Mehra","year":"2010","journal-title":"J Heart Lung Transplant"},{"key":"2026012113213650300_ehf214464-bib-0012","doi-asserted-by":"crossref","DOI":"10.3390\/metabo11100648","article-title":"Plasma lipidomic patterns in patients with symptomatic coronary microvascular dysfunction","volume":"11","author":"Lindner","year":"2021","journal-title":"Metabolites"},{"key":"2026012113213650300_ehf214464-bib-0013","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ijcard.2017.08.068","article-title":"International standardization of diagnostic criteria for microvascular angina","volume":"250","author":"Ong","year":"2018","journal-title":"Int J Cardiol"},{"key":"2026012113213650300_ehf214464-bib-0014","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.echo.2004.09.013","article-title":"Noninvasive detection of coronary allograft vasculopathy by myocardial contrast echocardiography","volume":"18","author":"Rodrigues","year":"2005","journal-title":"J Am Soc Echocardiogr"},{"key":"2026012113213650300_ehf214464-bib-0015","first-page":"494","article-title":"Quantitative assessment of cardiac allograft vasculopathy by real-time myocardial contrast echocardiography: a comparison with conventional echocardiographic analyses and [Tc99m]-sestamibi SPECT","volume":"9","author":"Hacker","year":"2008","journal-title":"Eur J Echocardiogr"},{"key":"2026012113213650300_ehf214464-bib-0016","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1161\/CIRCULATIONAHA.116.025268","article-title":"Coronary endothelial dysfunction and the index of microcirculatory resistance as a marker of subsequent development of cardiac allograft vasculopathy","volume":"11","author":"Lee","year":"2017","journal-title":"Circulation"},{"key":"2026012113213650300_ehf214464-bib-0017","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.jacc.2022.08.751","article-title":"Noninvasive physiologic assessment of cardiac allograft vasculopathy is prognostic for post-transplant events","volume":"80","author":"Clerkin","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026012113213650300_ehf214464-bib-0018","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1161\/CIRCULATIONAHA.119.043916","article-title":"Coronary microvascular dysfunction, left ventricular remodeling, and clinical outcomes in patients with chronic kidney impairment","volume":"141","author":"Bajaj","year":"2020","journal-title":"Circulation"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/10\/5\/3184\/66228013\/eschf_10_5_3184.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/10\/5\/3184\/66228013\/eschf_10_5_3184.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:26:26Z","timestamp":1769019986000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/10\/5\/3184\/8284417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,4]]},"references-count":18,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,7,4]]},"published-print":{"date-parts":[[2023,10,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.14464","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,10]]},"published":{"date-parts":[[2023,7,4]]},"assertion":[{"value":"2023-02-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}