With continued improvements in immunosuppressive therapy and management of rejection, the principal prob- lem limiting long term survival of patients following heart transplantation has been the development of cardiac allo- graft vasculopathy (CAV). Virtually all patients who sur- vive beyond one year have vascular changes of CAV with the extent and severity of involvement correlating with patients survival. The lack of consistent clinical signs and symptoms of CAV, the lack of reliable non-invasive test- ing, and the rapidity of progression with poor prognosis, have convinced most centres to perform annual coronary angiograms post-transplantation as a matter of policy.
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