Longitudinal Change and Predictors of Myocardial Flow Reserve by Positron Emission Tomography for the Evaluation of Cardiac Allograft Vasculopathy Following Heart Transplantation

•Myocardial flow reserve (MFR) on positron emission tomography longitudinally declines over time after heart transplantation and is prognostic for adverse post-transplant events.•Cardiometabolic risk factors, allograft rejection and cytomegalovirus infection are associated with reduced MFR and, therefore, the development and progression of cardiac allograft vasculopathy.•The use of moderate- to high-intensity statin therapy is associated with a higher MFR, and escalation of statin intensity may reduce the incidence of cardiac allograft vasculopathy.