title: Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?
abstract: OBJECTIVES We wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG).  METHODS Ninety-two patients with stable angina pectoris (and at least one occluded coronary artery) underwent MPS before, and 6 months after, undergoing CABG. The result of the MPS was kept secret from the surgeons.  RESULTS Before CABG, 90% of the patients had angina. After CABG, 97% of the patients were without symptoms. Overall graft patency was 84%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects and one patient had partly reversible defects. Of 83 perfusion defects, which were normalized after CABG, 67 were reversible (81%) or partly reversible (12%). Seventy-five percent of all reversible coronary artery territories before CABG were normalized after operation.  CONCLUSIONS Our results indicate that reversible or partly reversible perfusion defects at a preoperative MPS have a high chance of normalized myocardial perfusion assessed by MPS 6 months after operation. Normal perfusion is obtained almost exclusively in territories with reversible ischaemia. Symptoms improved in nearly all patients and LVEF in a significant fraction of the patients, not related to preoperative MPS.
authors.affiliation: Department of Cardiothoracic Surgery, Institute of Clinical Research, Odense University Hospital, Odense, Denmark. rozy@eckardtmail.dk
authors.forename: Rozy
authors.initials: R
authors.lastname: Eckardt
authors.forename: Bo Juel
authors.initials: BJ
authors.lastname: Kjeldsen
authors.forename: Allan
authors.initials: A
authors.lastname: Johansen
authors.forename: Peter
authors.initials: P
authors.lastname: Grupe
authors.forename: Torben
authors.initials: T
authors.lastname: Haghfelt
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.forename: Lars Ib
authors.initials: LI
authors.lastname: Andersen
authors.forename: Birger
authors.initials: B
authors.lastname: Hesse
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D013318:Stroke Volume; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi