title: Improved wall motion of late gadolinium-enhanced myocardium after complete surgical revascularization.
abstract: BACKGROUND
  Gadolinium-enhanced cardiac magnetic resonance (CMR) imaging suggests a low possibility of myocardial function improvement after revascularization if the transmural extent of late gadolinium enhancement (LGE) was over 50%. We evaluated myocardial wall motion in patients who underwent complete revascularization for left ventricular dysfunction.
  
  
  METHODS
  Thirty-three patients with left ventricular dysfunction (ejection fraction ≤ 0.35) underwent complete revascularization. Gadolinium-enhanced CMR was performed preoperatively and postoperatively (postoperative 24.1 ± 17.6 months). Postoperative coronary angiograms were also performed to confirm graft patency. Wall motion score and transmural extent of LGE were evaluated on a 16 segment model of short-axis images.
  
  
  RESULTS
  Of 528 total segments, 373 dysfunctional segments (70.6%; 189 hypokinesia, 177 akinesia, 6 dyskinesia, and 1 aneurysm) were evaluated for postoperative changes. When LGE was graded on a 5 point scale (absence of LGE, grade 0; LGE of 1% to 25%, grade 1; 26% to 50%, grade 2; 51% to 75%, grade 3; and 76% to 100%, grade 4), LGE was found in 221 (59%) segments (grades 1, n = 80; 2, n = 55; 3, n = 37; and 4, n = 49). After revascularization, wall motion improved in 72.1% (269 of 373) of dysfunctional segments (128 of 189 hypokinesia versus 141 of 184 akinesia; p = 0.055). Improved wall motion was observed in 77.0% (117 of 152), 67.5% (54 of 80), 69.1% (38 of 55), 86.5% (32 of 37), and 57.1% (28 of 49) of grades 0, 1, 2, 3, and 4 segments, respectively.
  
  
  CONCLUSIONS
  Improved motion of late gadolinium-enhanced myocardium, even in segments showing transmural LGE of 75% or greater and akinesia, was observed after complete revascularization. An inverse proportional correlation between the transmural extent of LGE and wall motion improvement was not observed.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea.
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Oh
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Eun-Ah
authors.initials: EA
authors.lastname: Park
authors.affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Whal
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ho Young
authors.initials: HY
authors.lastname: Hwang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea. Electronic address: kimkb@snu.ac.kr.
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA