Value of magnetic resonance imaging for the noninvasive detection of stenosis in coronary artery bypass grafts and recipient coronary arteries.
BACKGROUND
Magnetic resonance imaging (MRI) is a potential noninvasive diagnostic tool to detect coronary artery bypass graft stenosis, but its value in clinical practice remains to be established. We investigated the value of MRI in detecting stenotic grafts, including recipient vessels.


RESULTS
We screened for inclusion 173 consecutive patients who were scheduled for coronary angiography because of recurrent chest pain after coronary artery bypass grafting (CABG). We studied 69 eligible patients with 166 grafts (81 single vein, 44 sequential vein, and 41 arterial grafts). MRI with baseline and stress flow mapping was performed. Both scans were successful in 80% of grafts. Grafts were divided into groups with stenosis > or =50% (n=72) and > or =70% (n=48) in the graft or recipient vessels. Marginal logistic regression was used to predict the probability for the presence of stenosis per graft type using multiple MRI variables. Receiver operator characteristics (ROC) analysis was performed to assess the diagnostic value of MRI. Sensitivity (95% confidence interval)/specificity (95% confidence interval) in detecting single vein grafts with stenosis > or =50% and > or =70% were 94% (86 to 100)/63% (48 to 79) and 96% (87 to 100)/92% (84 to 100), respectively.


CONCLUSIONS
MRI with flow mapping is useful for identifying grafts and recipient vessels with flow-limiting stenosis. Flow scans could be obtained in 80% of the grafts. This proof-of-concept study suggests that noninvasive MRI detection of stenotic grafts in patients who present with recurrent chest pain after CABG may be useful in selecting those in need of an invasive procedure.
Langerak
Susan E
SE
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Vliegen
Hubert W
HW
Jukema
J Wouter
JW
Kunz
Patrik
P
Zwinderman
Aeilko H
AH
Lamb
Hildo J
HJ
van der Wall
Ernst E
EE
de Roos
Albert
A
D000241:Adenosine / Q000009:adverse effects; D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
D000241:Adenosine