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CARDIAC IMAGING

Functional significance of stenoses in coronary artery bypass grafts

Evaluation by single-photon emission computed tomography perfusion imaging, cardiovascular magnetic resonance, and angiography

Liesbeth P. Salm, MD^*,,, Jeroen J. Bax, MD, PhD^*,*, Hubert W. Vliegen, MD, PhD^*, Susan E. Langerak, MD, PhD^*, Petra Dibbets, MSc, J. Wouter Jukema, MD, PhD, FACC^*,, Hildo J. Lamb, PhD, Ernest K.J. Pauwels, MD, PhD, Albert de Roos, MD, PhD and Ernst E. van der Wall, MD, PhD, FACC^*,

^* Departments of *Cardiology
Radiology
Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands

Manuscript received February 11, 2004; revised manuscript received July 16, 2004, accepted July 29, 2004.

^* Reprint requests and correspondence: Dr. Jeroen J. Bax, Leiden University Medical Center, Department of Cardiology (C5-P), P.O. Box 9600, 2300 RC Leiden, The Netherlands (Email: jbax{at}knoware.nl).

OBJECTIVES: This study was designed to perform a head-to-head comparison between single-photon emission computed tomography (SPECT) and cardiovascular magnetic resonance (CMR) to evaluate hemodynamic significance of angiographic findings in bypass grafts.

BACKGROUND: The hemodynamic significance of a bypass graft stenosis may not always accurately be determined from the coronary angiogram. A variety of diagnostic tests (invasive or noninvasive) can further characterize the hemodynamic consequence of a lesion.

METHODS: Fifty-seven arterial and vein grafts in 25 patients were evaluated by angiography, SPECT perfusion imaging, and coronary flow velocity reserve determination by CMR. Based on angiography and SPECT, four different groups could be identified: 1) no significant stenosis (<50%), normal perfusion; 2) significant stenosis (50%), abnormal perfusion; 3) significant stenosis, normal perfusion (no hemodynamic significance); and 4) no significant stenosis, abnormal perfusion (suggesting microvascular disease).

RESULTS: A complete evaluation was obtained in 46 grafts. Single-photon emission computed tomography and CMR provided similar information in 37 of 46 grafts (80%), illustrating good agreement (kappa = 0.61, p < 0.001). Eight grafts perfused a territory with scar tissue. When agreement between SPECT and CMR was restricted to grafts without scar tissue, it improved to 84% (kappa = 0.68). Integration of angiography with SPECT categorized 14 lesions in group 1, 23 in group 2, 6 in group 3, and 3 in group 4. Single-photon emission computed tomography and CMR agreement per group was 86%, 78%, 100%, and 33%, respectively.

CONCLUSIONS: Head-to-head comparison showed good agreement between SPECT and CMR for functional evaluation of bypass grafts. Cardiovascular magnetic resonance may offer an alternative method to SPECT for functional characterization of angiographic lesions.

Abbreviations and Acronyms   APV = average peak velocity   CFVR = coronary flow velocity reserve   CMR = cardiovascular magnetic resonance   LV = left ventricular   QCA = quantitative coronary arteriography   SPECT = single-photon emission computed tomography   TFEPI = turbo field echo planar imaging