title: Comprehensive assessment of patients after coronary artery bypass grafting by 16-detector-row computed tomography.
abstract: BACKGROUND
  Multidetector-row computed tomography (MDCT) is a versatile modality to evaluate stenoses in native coronary arteries and bypass grafts. Acquired MDCT data can additionally be used to assess left ventricular ejection fraction (LVEF). The purpose was to use MDCT for the assessment of bypass graft and coronary artery disease combined with evaluation of LVEF.
  
  
  METHODS
  Twenty-five patients underwent 16-detector-row CT examination and coronary angiography. Bypass grafts and nongrafted coronary artery segments at MDCT were evaluated on eligibility, patency, and > or = 50% stenosis. The MDCT data set was used to calculate LVEF and was divided into patients with no/subendocardial/transmural myocardial infarctions (MIs).
  
  
  RESULTS
  Ninety vessels were evaluated: 14 arterial grafts/53 vein grafts/23 nongrafted vessels. Of 225 segments, 17 were ineligible for evaluation because of metal clips. With MDCT, patency in segments of arterial grafts/vein grafts/nongrafted vessels could be evaluated with high accuracy in 100%/100%/97% of segments. In arterial grafts, stenoses > or = 50% did not occur at angiography, which was for all eligible segments correctly diagnosed at MDCT. Stenosis > or = 50% could be correctly detected by MDCT with a sensitivity/specificity of 100%/94% for vein grafts and 100%/89% for nongrafted vessels. Negative predictive value was 100% for vein grafts and nongrafted vessels. In patients with transmural MI, MDCT revealed a significant lower LVEF as compared with patients without or with subendocardial MI (P < .05).
  
  
  CONCLUSIONS
  Comprehensive assessment of bypass grafts, nongrafted vessels, and LVEF is feasible with MDCT. Owing to the high negative predictive value this noninvasive approach may be used as gatekeeper before coronary angiography.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Liesbeth P
authors.initials: LP
authors.lastname: Salm
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed / Q000379:methods