Non-invasive imaging in heart transplant recipients: state of art and future direction

Imaging in heart transplantation is rapidly evolving from a primarily descriptive tool to a central component of predictive, precision-based graft surveillance. This review summarizes current and emerging roles of non-invasive imaging across the continuum of post-transplant care. Starting from the traditional use of imaging modalities such as echocardiography, computed tomography, magnetic resonance, nuclear imaging techniques, the focus is centered on the most recent evidence on the established techniques and the more recent advances, delineating gaps, and future directions towards routine clinical implementation. Overall, the review supports a paradigm shift in which multimodal, quantitative, and AI-enabled "precision imaging" could become integral to tailoring surveillance strategies, guiding therapy, and optimizing long-term outcomes for heart transplant recipients.