PMID- 20465836
OWN - NLM
STAT- MEDLINE
DCOM- 20100824
LR  - 20240117
IS  - 1532-429X (Electronic)
IS  - 1097-6647 (Print)
IS  - 1097-6647 (Linking)
VI  - 12
IP  - 1
DP  - 2010 May 13
TI  - Evaluation of contrast wash-in and peak enhancement in adenosine first pass 
      perfusion CMR in patients post bypass surgery.
PG  - 28
LID - 10.1186/1532-429X-12-28 [doi]
AB  - BACKGROUND: Adenosine first pass perfusion cardiovascular magnetic resonance 
      (CMR) yields excellent results for the detection of significant coronary artery 
      disease (CAD). In patients with coronary artery bypass grafts (CABG) the kinetics 
      of a contrast bolus may by altered only due to different distances through the 
      bypass grafts compared to native vessels, thereby possibly imitating a perfusion 
      defect. The aim of the study was to evaluate semiquantitative perfusion 
      parameters in order to assess possible differences in epicardial contrast 
      kinetics in areas supplied by native coronaries and CABG, both without 
      significant stenosis. METHODS: Twenty patients with invasive exclusion of 
      significant CAD (control group) and 38 patients with CABG without 
      angiographically significant (>or=50%) stenosis in unbypassed coronaries or 
      grafts were retrospectively included in the study. They underwent adenosine first 
      pass (0.05 mmol/kg Gd-DTPA) perfusion (3 short axis views/heart beat) and late 
      gadolinium enhancement (LGE) imaging 1 day before invasive coronary angiography. 
      Areas perfused by native coronaries and/or the different bypasses were identified 
      in X-ray angiography using the 16 segment model. In each of these areas upslope 
      and maximal signal intensity (SImax) relative to the left ventricular parameters, 
      time to 50% maximal signal intensity (TSI50%max) and time to maximal signal 
      intensity (TSImax) were calculated. RESULTS: In areas perfused by coronary 
      arteries with bypasses compared to native coronaries relative upslope and 
      relative SImax did not show a significant difference. TSI50%max and TSImax in 
      native coronaries and bypasses were 7.2s +/- 1.9s vs. 7.5s +/- 1.9s (p < 0.05) 
      and 12.6s +/- 3.0s vs. 13.1s +/- 3.0s (p < 0.05), respectively. The delay in Tmax 
      resulted in a significant (p < 0.05) delay of 0.5 +/- 1.1 heart beats (=images) 
      when adjusted to the heart rate. Differences in time were most pronounced in 
      areas perfused by left internal mammary artery grafts rather than by venous CABG, 
      but were also present between native vessel territories in patients without CAD, 
      albeit with smaller variability. CONCLUSION: Adenosine perfusion CMR in patients 
      post CABG may be associated with a short delay in contrast arrival. However, once 
      the contrast is in the myocardium there is similar wash-in kinetics and peak 
      enhancement. Therefore, since the delay is only short, the possibly differing 
      contrast kinetics through grafts and native vessels does not seem to be a 
      limiting factor for the accuracy of first pass adenosine perfusion in patients 
      post CABG.
FAU - Kelle, Sebastian
AU  - Kelle S
AD  - German Heart Institute Berlin, Germany.
FAU - Graf, Kristof
AU  - Graf K
FAU - Dreysse, Stefan
AU  - Dreysse S
FAU - Schnackenburg, Bernhard
AU  - Schnackenburg B
FAU - Fleck, Eckart
AU  - Fleck E
FAU - Klein, Christoph
AU  - Klein C
LA  - eng
PT  - Journal Article
DEP - 20100513
PL  - England
TA  - J Cardiovasc Magn Reson
JT  - Journal of cardiovascular magnetic resonance : official journal of the Society 
      for Cardiovascular Magnetic Resonance
JID - 9815616
RN  - 0 (Contrast Media)
RN  - K2I13DR72L (Gadolinium DTPA)
RN  - K72T3FS567 (Adenosine)
SB  - IM
MH  - *Adenosine
MH  - Adult
MH  - Aged
MH  - Constriction, Pathologic
MH  - *Contrast Media
MH  - Coronary Angiography
MH  - *Coronary Artery Bypass/adverse effects
MH  - *Coronary Circulation
MH  - Female
MH  - *Gadolinium DTPA
MH  - Graft Occlusion, Vascular/*diagnosis/etiology/physiopathology
MH  - Heart Rate
MH  - Humans
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocardial Perfusion Imaging/*methods
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Vascular Patency
PMC - PMC2887852
EDAT- 2010/05/15 06:00
MHDA- 2010/08/25 06:00
PMCR- 2010/05/13
CRDT- 2010/05/15 06:00
PHST- 2009/12/18 00:00 [received]
PHST- 2010/05/13 00:00 [accepted]
PHST- 2010/05/15 06:00 [entrez]
PHST- 2010/05/15 06:00 [pubmed]
PHST- 2010/08/25 06:00 [medline]
PHST- 2010/05/13 00:00 [pmc-release]
AID - S1097-6647(23)01308-X [pii]
AID - 1532-429X-12-28 [pii]
AID - 10.1186/1532-429X-12-28 [doi]
PST - epublish
SO  - J Cardiovasc Magn Reson. 2010 May 13;12(1):28. doi: 10.1186/1532-429X-12-28.