title: Quantitative gated myocardial perfusion single photon emission computed tomography improves the prediction of regional functional recovery in akinetic areas after coronary bypass surgery: useful tool for evaluation of myocardial viability.
abstract: OBJECTIVE
  Assessment of myocardial viability in akinetic areas is essential in surgery for ischemic heart disease, including coronary artery bypass grafting and left ventriculoplasty. The aim of this study is to evaluate the utility of quantitative indices of perfusion uptake, wall motion, and wall thickening of each region calculated by quantitative electrocardiogram-gated single photon emission computed tomography (SPECT) for prediction of functional recovery after coronary artery bypass grafting.
  
  
  METHODS
  Forty patients scheduled for coronary artery bypass grafting were prospectively included. Electrocardiogram-gated SPECT was performed before and 1 week and 3 months after operation, and coronary angiography was performed before and after operation. The myocardium was divided into 9 segments and myocardial viability, assessed by improvement of the wall motion score using a cine mode display, and evaluated by radionuclide criteria (perfusion uptake, wall motion, wall thickening). Twenty-four segments with moderate hypokinesis and 14 segments with akinesis with patent grafts were assessed.
  
  
  RESULTS
  All segments with moderate hypokinesis except 1 (96%) had improved wall motion scores postoperatively, whereas of 14 segments with akinesis only 7 segments (50%) had improved wall motion scores. The preoperative perfusion uptake in the improved segments was significantly higher than in the nonimproved segments (62.7% +/- 15.6% vs 46.4% +/- 24.5%, P =.01). There was a significant difference in wall motion between the improved and nonimproved segments (3.8 +/- 2.2 mm vs 1.4 +/- 1.4 mm, P =.001), and the preoperative wall thickening of the improved segments was significantly higher than in the nonimproved segments (27.2% +/- 14.1% vs 8.2% +/- 10.3%, P <.0001). The optimal cutoff level of perfusion uptake was 50%, with the highest accuracy of 72%, and the optimal cutoff levels of wall thickening and wall motion were 10% and 1.5 mm, with the highest accuracies of 76% and 85%, respectively.
  
  
  CONCLUSIONS
  The regional functional index calculated by electrocardiogram-gated SPECT indicated that wall thickening was well correlated with functional recovery compared with wall motion or perfusion uptake. This suggests that the wall thickening calculated by electrocardiogram-gated SPECT may be more useful to predict functional recovery than regional myocardial perfusion. Or, it could suggest that in addition to perfusion uptake, wall thickening could enhance the objective assessment of myocardial viability.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. muratosh@med.hokkaido.ac.jp
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Murashita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Makino
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kamikubo
authors.forename: Keishu
authors.initials: K
authors.lastname: Yasuda
authors.forename: Megumi
authors.initials: M
authors.lastname: Mabuchi
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left