Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 29;79(12):1141-1151.
doi: 10.1016/j.jacc.2021.12.037.

Quantitative Myocardial Perfusion Predicts Outcomes in Patients With Prior Surgical Revascularization

Andreas Seraphim  1 , Benjamin Dowsing  2 , Krishnaraj S Rathod  2 , Hunain Shiwani  3 , Kush Patel  3 , Kristopher D Knott  4 , Sameer Zaman  5 , Ieuan Johns  5 , Yousuf Razvi  6 , Rishi Patel  6 , Hui Xue  7 , Daniel A Jones  2 , Marianna Fontana  8 , Graham Cole  6 , Rakesh Uppal  9 , Rhodri Davies  3 , James C Moon  3 , Peter Kellman  7 , Charlotte Manisty  10
Affiliations

Quantitative Myocardial Perfusion Predicts Outcomes in Patients With Prior Surgical Revascularization

Andreas Seraphim et al. J Am Coll Cardiol. .

Abstract

Background: Patients with previous coronary artery bypass graft (CABG) surgery typically have complex coronary disease and remain at high risk of adverse events. Quantitative myocardial perfusion indices predict outcomes in native vessel disease, but their prognostic performance in patients with prior CABG is unknown.

Objectives: In this study, we sought to evaluate whether global stress myocardial blood flow (MBF) and perfusion reserve (MPR) derived from perfusion mapping cardiac magnetic resonance (CMR) independently predict adverse outcomes in patients with prior CABG.

Methods: This was a retrospective analysis of consecutive patients with prior CABG referred for adenosine stress perfusion CMR. Perfusion mapping was performed in-line with automated quantification of MBF. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events defined as nonfatal myocardial infarction and unplanned revascularization. Associations were evaluated with the use of Cox proportional hazards models after adjusting for comorbidities and CMR parameters.

Results: A total of 341 patients (median age 67 years, 86% male) were included. Over a median follow-up of 638 days (IQR: 367-976 days), 81 patients (24%) reached the primary outcome. Both stress MBF and MPR independently predicted outcomes after adjusting for known prognostic factors (regional ischemia, infarction). The adjusted hazard ratio (HR) for 1 mL/g/min of decrease in stress MBF was 2.56 (95% CI: 1.45-4.35) and for 1 unit of decrease in MPR was 1.61 (95% CI: 1.08-2.38).

Conclusions: Global stress MBF and MPR derived from perfusion CMR independently predict adverse outcomes in patients with previous CABG. This effect is independent from the presence of regional ischemia on visual assessment and the extent of previous infarction.

Keywords: CABG; blood flow; mapping; perfusion reserve.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures This study was supported by a Clinical Research Training Fellowship (Dr Seraphim) from the British Heart Foundation (FS/18/83/34025) and directly and indirectly from the National Institute for Health Research Biomedical Research Centres at University College London Hospitals and Barts Health National Health Service Trusts. This work forms part of the research areas contributing to the translational research portfolio of the Biomedical Research Centre at Barts that is supported and funded by the National Institute for Health Research. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Inducible ischaemia interpretation and analysis of stress myocardial blood flow (MBF).
A: First pass perfusion imaging of basal, mid and apical short axis slices. B: Quantitative perfusion mapping with estimation of global and segmental MBF (C). D: LGE imaging at the corresponding short axis slice positions shows segments with previous infarction that correlate with the stress perfusion defects shown in A and B. In this patient, no inducible perfusion defect was demonstrated.
Figure 2.
Figure 2.. Kaplan-Meier event-free survival curves for myocardial perfusion reserve (MPR).
Event-free survival curves for death and major adverse cardiovascular events (nonfatal myocardial infarction and unplanned revascularization) according to MPR. Lower MPR was associated with higher rates of events (log-rank p=0.041 respectively).
Central illustration.
Central illustration.. Quantitative myocardial perfusion predicts outcomes in patients with prior surgical revascularization.
Top: Perfusion mapping permits the fully quantitative estimation of global and regional stress myocardial blood flow (MBF) and perfusion reserve (MPR). Bottom: Event-free survival curve for death and major adverse cardiovascular events (non-fatal myocardial infarction and unplanned revascularization) according to stress myocardial blood flow. Lower stress MBF was associated with higher rates of events (log-rank p<0.001).
See this image and copyright information in PMC

Comment in

References

    1. Janiec M, Nazari Shafti TZ, Dimberg A, Lagerqvist B, Lindblom RPF. Graft failure and recurrence of symptoms after coronary artery bypass grafting. Scand Cardiovasc J SCJ. 2018;52(3):113–9. - PubMed
    1. Nagel E, Greenwood JP, McCann GP, Bettencourt N, Shah AM, Hussain ST, et al. Magnetic Resonance Perfusion or Fractional Flow Reserve in Coronary Disease. N Engl J Med. 2019. 20;380(25):2418–28. - PubMed
    1. Kwong RY, Ge Y, Steel K, Bingham S, Abdullah S, Fujikura K, et al. Cardiac Magnetic Resonance Stress Perfusion Imaging for Evaluation of Patients With Chest Pain. J Am Coll Cardiol. 2019. Oct 8;74(14):1741–55. - PMC - PubMed
    1. Kinnel M, Sanguineti F, Pezel T, Unterseeh T, Hovasse T, Toupin S, et al.. Prognostic value of vasodilator stress perfusion CMR in patients with previous coronary artery bypass graft. Eur Heart J - Cardiovasc Imaging [Internet]. 2020. Dec 13 [cited 2020 Dec 23];(jeaa316). Available from: 10.1093/ehjci/jeaa316 - DOI - PubMed
    1. Bernhardt P, Spiess J, Levenson B, Pilz G, Höfling B, Hombach V, et al. Combined assessment of myocardial perfusion and late gadolinium enhancement in patients after percutaneous coronary intervention or bypass grafts: a multicenter study of an integrated cardiovascular magnetic resonance protocol. JACC Cardiovasc Imaging. 2009. Nov;2(11):1292–300. - PubMed

Publication types