Utility of nuclear stress imaging for detecting coronary artery bypass graft disease

Basel Al Aloul, Mackenzi Mbai, Selcuk Adabag, Santiago Garcia, Hoang Thai, Steven Goldman, William Holman, Gulshan Sethi, Rosemary Kelly, Herbert B. Ward, Edward O. McFalls

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7 Scopus citations

Abstract

Background: The value of Single Photon Emission Computed Tomography stress myocardial perfusion imaging (SPECT-MPI) for detecting graft disease after coronary artery bypass surgery (CABG) has not been studied prospectively in an unselected cohort.Methods: Radial Artery Versus Saphenous Vein Graft Study is a Veterans Affairs Cooperative Study to determine graft patency rates after CABG surgery. Seventy-nine participants agreed to SPECT-MPI within 24 hours of their coronary angiogram, one-year after CABG. The choice of the stress protocol was made at the discretion of the nuclear radiologist and was either a symptom-limited exercise test (n = 68) or an adenosine infusion (n = 11). The SPECT-MPI results were interpreted independent of the angiographic results and estimates of sensitivity, specificity and accuracy were based on the prediction of a graft stenosis of ≥70% on coronary angiogram.Results: A significant stenosis was present in 38 (48%) of 79 patients and 56 (22%) of 251 grafts. In those stress tests with an optimal exercise heart rate response (>80% maximum predicted heart rate) (n = 26) sensitivity, specificity and accuracy of SPECT-MPI for predicting the graft stenosis was 77%, 69% and 73% respectively. With adenosine (n = 11) it was 75%, 57% and 64%, respectively. Among participants with a suboptimal exercise heart rate response, the sensitivity of SPECT-MPI for predicting a graft stenosis was <50%. The accuracy of SPECT-MPI for detecting graft disease did not vary significantly with ischemic territory.Conclusions: Under optimal stress conditions, SPECT-MPI has a good sensitivity and accuracy for detecting graft disease in an unselected patient population 1 year post-CABG.

Original languageEnglish (US)
Article number62
JournalBMC Cardiovascular Disorders
Volume12
DOIs
Publication statusPublished - Aug 3 2012
Externally publishedYes

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Keywords

  • CABG
  • Cardiac catheterization/intervention
  • Coronary artery bypass grafts
  • Coronary artery imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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