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Korean J Radiol. 2014 Mar-Apr;15(2):277-85. doi: 10.3348/kjr.2014.15.2.277. Epub 2014 Mar 7.

Impaired coronary flow reserve is the most important marker of viable myocardium in the myocardial segment-based analysis of dual-isotope gated myocardial perfusion single-photon emission computed tomography.

Author information

1
Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul 110-744, Korea.
2
Department of Nuclear Medicine, Konkuk University School of Medicine, Seoul 143-729, Korea.
3
Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.
4
Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul 110-744, Korea. ; Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Korea.

Abstract

OBJECTIVE:

The aim of this study was to investigate the most robust predictor of myocardial viability among stress/rest reversibility (coronary flow reserve [CFR] impairment), (201)Tl perfusion status at rest, (201)Tl 24 hours redistribution and systolic wall thickening of (99m)Tc-methoxyisobutylisonitrile using a dual isotope gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) who were re-vascularized with a coronary artery bypass graft (CABG) surgery.

MATERIALS AND METHODS:

A total of 39 patients with CAD was enrolled (34 men and 5 women), aged between 36 and 72 years (mean 58 ± 8 standard in years) who underwent both pre- and 3 months post-CABG myocardial SPECT. We analyzed 17 myocardial segments per patient. Perfusion status and wall motion were semi-quantitatively evaluated using a 4-point grading system. Viable myocardium was defined as dysfunctional myocardium which showed wall motion improvement after CABG.

RESULTS:

The left ventricular ejection fraction (LVEF) significantly increased from 37.8 ± 9.0% to 45.5 ± 12.3% (p < 0.001) in 22 patients who had a pre-CABG LVEF lower than 50%. Among 590 myocardial segments in the re-vascularized area, 115 showed abnormal wall motion before CABG and 73.9% (85 of 115) had wall motion improvement after CABG. In the univariate analysis (n = 115 segments), stress/rest reversibility (p < 0.001) and (201)Tl rest perfusion status (p = 0.024) were significant predictors of wall motion improvement. However, in multiple logistic regression analysis, stress/rest reversibility alone was a significant predictor for post-CABG wall motion improvement (p < 0.001).

CONCLUSION:

Stress/rest reversibility (impaired CFR) during dual-isotope gated myocardial perfusion SPECT was the single most important predictor of wall motion improvement after CABG.

KEYWORDS:

Coronary artery bypass grafting; Ischemia; Myocardium; Single-photon emission-computed tomography; Tissue viability

PMID:
24642696
PMCID:
PMC3955796
DOI:
10.3348/kjr.2014.15.2.277
[Indexed for MEDLINE]
Free PMC Article
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