Abstract
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Objectives In this study, delayed redistribution (DR) SPECT was compared with delayed-enhancement (DE) MRI for prediction of functional recovery after coronary artery bypass graft (CABG) surgery.
Methods A total of 39 coronary artery disease patients who underwent preoperative Tl-201 rest/ gated Tc-99m-MIBI/ 24-h DR SPECT, and DE-MRI were enrolled. Gated SPECT was performed again 3-month after CABG. Using a 19-segment model, segmental perfusion, thickening, and 24-h DR were measured using automatic software. Segmental DE (SDE) on MRI was defined as a product of DE transmurality and extent. Final analysis included 304 dysfunctional segments with successful CABG. Functional recovery was determined by 3-month SPECT and predictive values of 24-h segmental DR (SDR) on SPECT and SDE were assessed.
Results In receiver-operating characteristic curve analyses, the areas under the curve of SDR and SDE for functional recovery were 0.735 and 0.705, respectively (p=0.426). With the optimal cutoff, the sensitivities of SDR and SDE were 84 and 78% (p=0.424), and the specificities, 55 and 59%, respectively (p=0.386). SDR and SDE produced concordant prediction in 205 segments (67%). Among the discordant 99 segments, the proportions of functional recovery were not significantly different between the SDR-only and the SDE-only positive groups (19 and 13%, p=0.529). However, the coronary perfusion reserve on SPECT was higher in SDR-only positive group than in SDE-only positive group (p=0.005).
Conclusions DR SPECT and DE-MRI possess comparable predictive value for functional recovery after revascularization. Although most cases showed concordant results, discordant cases exhibited different characteristics such as coronary perfusion reserve, with similar functional recovery. Therefore, each of DR SPECT and DE-MRI may have independent implication for myocardial viability assessment
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