Nuclear imaging techniques in the assessment of myocardial perfusion and function after CABG: does it correlate with CK-MB elevation?
BACKGROUND
An increase of the creatine kinase MB (CK-MB) isoenzyme after cardiac surgery suggests perioperative myocardial infarction. The interpretation is more difficult when increased enzymes are not accompanied by electrocardiographic markers of infarction. The aim of this study was to correlate the results of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV) with CK-MB isoenzyme level in patients without ECG abnormalities after CABG.


METHODS
36 patients (age: 52.5 +/- 8.5 years, 33M/3F) treated with CABG were prospectively studied. CK-MB level was assessed at 0, 4, 8, 12, 24, 36, 48 and 72 hours after surgery. MPI (SPECT using Tc-99m-MIBI) and RNV were performed 2 weeks before and 3-4 months after surgery. All patients had an uneventful hospitalisation. The subjects were divided into two groups: group 1 with CK-MB increase > 50 IU/ml (n = 9) and group 2 with CK-MB levels </= 50 IU/ml (n = 27). There was no difference between the groups regarding the number of diseased arteries, haemodynamic parameters, aortic clamping time or the number of grafts.


RESULTS
Perfusion improvement at stress and at rest was significantly lower in group 1 than in group 2. The ejection fraction did not change significantly in both groups (DeltaEF = 0.6 +/- 13.5 in group 1 v. 0.7 +/- 9.7 in group 2, p = NS), however, in 5 patients from group 1 (56%) and in 6 patients from group 2 (22%) the EF decreased significantly at follow-up RNV (p = 0.05). In 6 patients (5 in group 1 and 1 in group 2) a new defect of perfusion was found at follow-up MPI. The sensitivity and specificity of increased CK-MB level in predicting perfusion deterioration were 83% and 87%, respectively.


CONCLUSIONS
We conclude that patients with an increased level of CK-MB isoenzyme (> 50 IU/ml) after coronary artery surgery have a higher rate of perfusion and function deterioration. The increase of CK-MB level early after coronary bypass surgery in patients without ECG markers of perioperative infarction indicates a probable ischaemic insult during surgery.
Department of Cardiac Surgery, University School of Medical Sciences, Poznań, Poland. pawelkwinecki@interia.pl
Paweł
P
Kwinecki
Marek
M
Jemielity
Rafał
R
Czepczyński
Artur
A
Baszko
Marek
M
Ruchała
Jerzy
J
Sowiński
Wojciech
W
Dyszkiewicz
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D011182:Postoperative Care; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D015646:Ventriculography, First-Pass
D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form