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BACKGROUND: Despite the accepted utility of delayed-enhancement MRI in identifying irreversible myocardial injury, no study has yet assessed its role as a viability tool exclusively in the setting of coronary artery bypass surgery (CABG), and no study has repeated delayed-enhancement MRI late after revascularization. In a clinical trial in which patients underwent CABG by either the off-pump or on-pump surgical technique, we hypothesized that (1) preoperative delayed-enhancement MRI would have high diagnostic accuracy in predicting viability and (2) the occurrence of perioperative myocardial necrosis would affect late regional wall motion recovery. METHODS AND RESULTS: Fifty-two patients undergoing multivessel CABG were studied by preoperative and early (day 6) and late (6 months) postoperative cine MRI for global and regional functional assessment and delayed-enhancement MRI for assessment of irreversible myocardial injury. Preoperatively, 611 segments (21%) had abnormal regional function, whereas 421 segments (14%) showed evidence of hyperenhancement. At 6 months after revascularization, 57% (343 of 611) of dysfunctional segments improved contraction by at least 1 grade. When all preoperative dysfunctional segments were analyzed, there was a strong correlation between the transmural extent of hyperenhancement and the recovery in regional function at 6 months (P<0.001). Of a total of 96 previously dysfunctional but nonenhancing or minimally hyperenhancing myocardial segments that did not improve regional function at 6 months, 35 (36%) demonstrated new perioperative hyperenhancement in the early postoperative MRI scan. CONCLUSIONS: Delayed-enhancement MRI is a powerful predictor of myocardial viability after surgery, suggesting an important role for this technique in clinical viability assessment.

Original publication

DOI

10.1161/01.CIR.0000142045.22628.74

Type

Journal article

Journal

Circulation

Publication Date

21/09/2004

Volume

110

Pages

1535 - 1541

Keywords

Aged, Cohort Studies, Contrast Media, Coronary Artery Bypass, Coronary Artery Bypass, Off-Pump, Female, Follow-Up Studies, Gadolinium DTPA, Humans, Magnetic Resonance Imaging, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Myocardial Contraction, Myocardial Reperfusion Injury, Myocardium, Necrosis, Observer Variation, Postoperative Period, Randomized Controlled Trials as Topic