title: Magnetic resonance vs technetium-99m pyrophosphate scintigraphy in the detection of perioperative myocardial necrosis.
abstract: BACKGROUND
  Perioperative myocardial infarction (POMI) is a complication of coronary artery bypass grafting (CABG) with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS) is used in the diagnosis of POMI; however it shows a limited sensitivity for subendocardial lesions. Cardiovascular magnetic resonance imaging (CMRI), in turn, has a high accuracy in the detection of myocardial necrosis.
  
  
  OBJECTIVE
  To compare CMRI and MS for the detection of POMI after CABG.
  
  
  METHODS
  A total of 24 patients with chronic coronary artery disease were studied using the delayed contrast enhanced CMRI and MS before and after CABG by analyzing the development of areas of perioperative myocardial necrosis (POMI). Biochemical markers of myocardial injury (CKMB and troponin I) were also determined before and after surgery.
  
  
  RESULTS
  Nineteen patients completed the study. Of these, 6 (32%) presented POMI on CMRI and 4 (21%) on MS (p = NS). Of the 323 left ventricular segments assessed, 17 (5.3%) showed perioperative necrosis on CMRI and 7 (2.2%) on MS (p = 0.013). Moderate agreement was observed between the methods (kappa = 0.46). There was disagreement regarding the diagnosis of POMI in 4 (21%) cases, most of them with small areas of perioperative necrosis on CMRI which were not visualized on MS. In all cases with POMI on CMRI, significant CKMB and troponin I elevations were observed.
  
  
  CONCLUSIONS
  Moderate diagnostic agreement was observed between the methods for the detection of POMI, but CMRI enabled visualization of small areas of perioperative myocardial necrosis which were not identified on MS and were associated with elevation of biochemical markers of myocardial injury.
authors: Instituto do Coração - Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil. gumonte@cardiol.br
authors: Guilherme Urpia
authors: GU
authors: Monte
authors: Luciano Ferreira
authors: LF
authors: Drager
authors: Fábio Solano de Freitas
authors: FS
authors: Souza
authors: Luiz Francisco Rodrigues de
authors: LF
authors: Avila
authors: José Rodrigues
authors: JR
authors: Parga Filho
authors: Luiz Antônio Machado
authors: LA
authors: César
authors: Marisa
authors: M
authors: Izaki
authors: José Cláudio
authors: JC
authors: Meneghetti
authors: Carlos Eduardo
authors: CE
authors: Rochitte
authors: Roberto
authors: R
authors: Kalil Filho
mesh_terms: D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003327:Coronary Disease / Q000097:blood / Q000601:surgery*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology*; D009204:Myocardial Revascularization; D009336:Necrosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D016698:Technetium Tc 99m Pyrophosphate; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019275:Radiopharmaceuticals; D019210:Troponin I; D016698:Technetium Tc 99m Pyrophosphate; D052279:Creatine Kinase, MB Form