PMID- 19580726
OWN - NLM
STAT- MEDLINE
DCOM- 20090917
LR  - 20211028
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 2
IP  - 4
DP  - 2009 Apr
TI  - Magnetic resonance adenosine perfusion imaging in patients after coronary artery 
      bypass graft surgery.
PG  - 437-45
LID - 10.1016/j.jcmg.2008.12.016 [doi]
AB  - OBJECTIVES: The aim of the study was to evaluate the feasibility and diagnostic 
      performance of the combination of adenosine stress perfusion and late gadolinium 
      enhancement (LGE) in patients after coronary artery bypass graft surgery (CABG). 
      BACKGROUND: Cardiac magnetic resonance (CMR) imaging allows the detection of 
      significant coronary artery disease by adenosine stress perfusion and infarct 
      imaging. Myocardial contrast kinetics may be altered in patients after CABG owing 
      to more complex myocardial perfusion and different distances of the contrast 
      bolus through different bypasses and native coronary vessels. Additionally, all 
      studies have excluded patients after CABG. METHODS: In all, 78 patients (age 66 
      +/- 8 years; 71 men) underwent CMR imaging including left ventricular function, 
      first-pass adenosine stress perfusion (adenosine 140 microg/min/kg) using 0.05 
      mmol/kg body weight gadolinium-diethylenetriaminepenta-acetic acid and an 
      additional 0.15 mmol/kg for LGE 1 day before invasive coronary angiography. 
      Images were analyzed visually using the speed of contrast wash-in and maximal 
      signal intensity. Transmural LGE defects of the size of a vessel or graft 
      territory defined by angiography were considered true negatives, even when 
      supplied by a stenosed/occluded vessel/graft. Stenoses >50% in grafts and grafted 
      or ungrafted native vessels (diameter > or =2 mm) in invasive angiography were 
      considered significant. RESULTS: The prevalence of patients with significant 
      stenosis was 63% (69% functionally 1-vessel, 28% 2-vessel, and 3% 3-vessel 
      disease). Sensitivity and specificity were 77% and 90%, respectively, on a 
      patient basis, and 71% and 89% on a vessel territory basis. Sensitivity, if only 
      areas supplied by grafts (n = 196) were evaluated, was 78% and specificity was 
      94%, compared with territories supplied by ungrafted native vessels (n = 51) with 
      sensitivity and specificity of 63% and 91%, respectively. Sensitivity and 
      specificity for the 53 areas with prior infarction were 88% and 79%, 
      respectively. CONCLUSIONS: For patients after surgical revascularization, the 
      combination of stress perfusion and LGE yields good diagnostic accuracy for the 
      detection and localization of significant stenoses. However, sensitivity is 
      reduced compared with published data in patients without CABG. Prior myocardial 
      infarction can be examined without loss of accuracy.
FAU - Klein, Christoph
AU  - Klein C
AD  - German Heart Institute, Berlin, Germany. klein@dhzb.de
FAU - Nagel, Eike
AU  - Nagel E
FAU - Gebker, Rolf
AU  - Gebker R
FAU - Kelle, Sebastian
AU  - Kelle S
FAU - Schnackenburg, Bernhard
AU  - Schnackenburg B
FAU - Graf, Kristof
AU  - Graf K
FAU - Dreysse, Stefan
AU  - Dreysse S
FAU - Fleck, Eckart
AU  - Fleck E
LA  - eng
GR  - FS/10/029/28253/BHF_/British Heart Foundation/United Kingdom
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Contrast Media)
RN  - 0 (Vasodilator Agents)
RN  - K2I13DR72L (Gadolinium DTPA)
RN  - K72T3FS567 (Adenosine)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2009 Apr;2(4):446-8. PMID: 19580727
MH  - *Adenosine
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Angina Pectoris/diagnosis/etiology
MH  - *Contrast Media
MH  - Coronary Angiography
MH  - *Coronary Artery Bypass
MH  - Coronary Stenosis/complications/*diagnosis/physiopathology/surgery
MH  - Feasibility Studies
MH  - Female
MH  - *Gadolinium DTPA
MH  - Humans
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnosis/etiology
MH  - *Myocardial Perfusion Imaging
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Recurrence
MH  - Sensitivity and Specificity
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Patency
MH  - *Vasodilator Agents
EDAT- 2009/07/08 09:00
MHDA- 2009/09/18 06:00
CRDT- 2009/07/08 09:00
PHST- 2008/06/27 00:00 [received]
PHST- 2008/12/02 00:00 [revised]
PHST- 2008/12/05 00:00 [accepted]
PHST- 2009/07/08 09:00 [entrez]
PHST- 2009/07/08 09:00 [pubmed]
PHST- 2009/09/18 06:00 [medline]
AID - S1936-878X(09)00039-4 [pii]
AID - 10.1016/j.jcmg.2008.12.016 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2009 Apr;2(4):437-45. doi: 10.1016/j.jcmg.2008.12.016.