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Seraphim A, Knott KD, Beirne AM, Augusto JB, Menacho K, Artico J, Joy G, Hughes R, Bhuva AN, Torii R, Xue H, Treibel TA, Davies R, Moon JC, Jones DA, Kellman P, Manisty C. Use of quantitative cardiovascular magnetic resonance myocardial perfusion mapping for characterization of ischemia in patients with left internal mammary coronary artery bypass grafts. J Cardiovasc Magn Reson 2021; 23:82. [PMID: 34134696 PMCID: PMC8210347 DOI: 10.1186/s12968-021-00763-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantitative myocardial perfusion mapping using cardiovascular magnetic resonance (CMR) is validated for myocardial blood flow (MBF) estimation in native vessel coronary artery disease (CAD). Following coronary artery bypass graft (CABG) surgery, perfusion defects are often detected in territories supplied by the left internal mammary artery (LIMA) graft, but their interpretation and subsequent clinical management is variable. METHODS We assessed myocardial perfusion using quantitative CMR perfusion mapping in 38 patients with prior CABG surgery, all with angiographically-proven patent LIMA grafts to the left anterior descending coronary artery (LAD) and no prior infarction in the LAD territory. Factors potentially determining MBF in the LIMA-LAD myocardial territory, including the impact of delayed contrast arrival through the LIMA graft were evaluated. RESULTS Perfusion defects were reported on blinded visual analysis in the LIMA-LAD territory in 27 (71%) cases, despite LIMA graft patency and no LAD infarction. Native LAD chronic total occlusion (CTO) was a strong independent predictor of stress MBF (B = - 0.41, p = 0.014) and myocardial perfusion reserve (MPR) (B = - 0.56, p = 0.005), and was associated with reduced stress MBF in the basal (1.47 vs 2.07 ml/g/min; p = 0.002) but not the apical myocardial segments (1.52 vs 1.87 ml/g/min; p = 0.057). Extending the maximum arterial time delay incorporated in the quantitative perfusion algorithm, resulted only in a small increase (3.4%) of estimated stress MBF. CONCLUSIONS Perfusion defects are frequently detected in LIMA-LAD subtended territories post CABG despite LIMA patency. Although delayed contrast arrival through LIMA grafts causes a small underestimation of MBF, perfusion defects are likely to reflect true reductions in myocardial blood flow, largely due to proximal native LAD disease.
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Affiliation(s)
- Andreas Seraphim
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Kristopher D Knott
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anne-Marie Beirne
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Joao B Augusto
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Katia Menacho
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Jessica Artico
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - George Joy
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Rebecca Hughes
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Anish N Bhuva
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Hui Xue
- DHHS, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Rhodri Davies
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
| | - Daniel A Jones
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Peter Kellman
- DHHS, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK.
- Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.
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