Functional significance of stenoses in coronary artery bypass grafts. Evaluation by single-photon emission computed tomography perfusion imaging, cardiovascular magnetic resonance, and angiography.
OBJECTIVE
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.
Salm
Liesbeth P
LP
Department of Cardiology, Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
Bax
Jeroen J
JJ
Vliegen
Hubert W
HW
Langerak
Susan E
SE
Dibbets
Petra
P
Jukema
J Wouter
JW
Lamb
Hildo J
HJ
Pauwels
Ernest K J
EK
de Roos
Albert
A
van der Wall
Ernst E
EE
D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity / Q000502:physiology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D013318:Stroke Volume / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome