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CLINICAL STUDY: CARDIAC MAGNETIC RESONANCE STUDIES

Assessment of coronary artery bypass graft disease using cardiovascular magnetic resonance determination of flow reserve

Willemijn L. F. Bedaux, MD^*||,*, Mark B. M. Hofman, PhD, Stefan L. A. Vyt, MD, Jean G. F. Bronzwaer, MD^*, Cees A. Visser, MD, PhD^* and Albert C. van Rossum, MD, PhD^*||

^* Department of Cardiology, Amsterdam, The Netherlands
Department of Clinical Physics and Informatics, Amsterdam, The Netherlands
Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
Institute for Cardiovascular Research ICaR-VU, Amsterdam, The Netherlands
^|| Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands

Manuscript received February 20, 2002; revised manuscript received June 9, 2002, accepted July 24, 2002.

^* Reprint requests and correspondence: Dr. Willemijn L. F. Bedaux, Department of Cardiology, VU University Medical Center, Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
wlf.bedaux{at}VUmc.nl

OBJECTIVES: The purpose of this study was to assess the value of cardiovascular magnetic resonance (CMR)–determined graft flow and flow reserve in differentiating significant from non-significant vein graft disease.

BACKGROUND: In patients after coronary artery bypass grafting (CABG), non-invasive testing may be helpful in the detection of recurrent graft disease.

METHODS: Randomly selected patients (n = 21) scheduled for X-ray angiography because of recurrent chest complaints after CABG were included for evaluation of vein grafts (n = 40) by CMR. Three-dimensional contrast-enhanced CMR angiography was performed and followed by flow measurements at rest and during hyperemia in patent grafts only. Flow reserve was calculated when resting flow exceeded 20 ml/min. Analysis was based on four categories defined by X-ray angiography: occluded grafts (n = 3), grafts with stenosis >50% (n = 19), grafts with stenosis <50% with diseased graft run-off (n = 8), and grafts with stenosis <50% and normal run-off (n = 10).

RESULTS: The CMR angiography demonstrated occlusion of three grafts. In nine of the 37 patent grafts, basal blood flow was <20 ml/min, all demonstrating significant stenosis at X-ray angiography. In grafts with resting flow >20 ml/min (n = 28), flow reserve significantly differed between grafts without stenosis and grafts with significant stenosis or with diseased run-off (2.5 ± 0.7 vs. 1.8 ± 0.9, p = 0.04). An algorithm combining basal volume flow <20 ml/min and graft flow reserve <2 had a sensitivity and specificity of 78% and 80% respectively for detecting grafts with significant stenosis or diseased run-off.

CONCLUSIONS: This feasibility study showed that quantification of flow and flow reserve by CMR may serve as a non-invasive adjunct to differentiate between vein grafts without stenosis and grafts with significant stenosis or diseased run-off.

Abbreviations and Acronyms   CABG   coronary artery bypass grafting   CMR   cardiovascular magnetic resonance   3D   three-dimensional

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