Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku, Finland.
Heart Center, Turku University Hospital and University of Turku, Hämeentie 11, Turku, Finland.
Eur Heart J Cardiovasc Imaging. 2019 Nov 1;20(11):1298-1304. doi: 10.1093/ehjci/jey160.
Recurrent chest pain after coronary artery bypass grafting (CABG) poses a diagnostic challenge. We hypothesized that combining anatomy of bypass grafts and native coronary arteries with ischaemia detection by hybrid imaging could be used to gain valuable and complementary information in patients with recurrent symptoms after CABG.
We analysed 36 consecutive patients (67 ± 9 years, 81% male) who had undergone hybrid imaging using coronary computed tomography angiography (CCTA) and [15O]H2O positron emission tomography (PET) myocardial perfusion imaging due to recurrent symptoms after CABG. Coronary tree and left ventricular myocardium were divided into three main territories, yielding a total of 108 coronary territories in 36 patients. The presence of obstructive (≥50%) stenosis and the patency of grafts were evaluated by CCTA, while myocardial ischaemia was assessed by quantitative adenosine-stress PET. Altogether 28 (78%) of the 36 study patients presented with matched PET/CCTA abnormalities. Forty-one coronary territories were supplied by non-obstructed bypass grafts or native coronary arteries (protected territory). However, 12 (29%) of these presented with a perfusion defect. In six cases, the perfusion defect involved myocardium distal to the graft-coronary anastomosis, as interpreted on the PET/CCTA fusion images. In turn, in 48 coronary territories the supplying artery was obstructed on CCTA (unprotected territory). Of these, 41 (85%, P < 0.001 vs. protected) presented with abnormal perfusion, involving myocardium distal to the anastomosis in 29 cases.
Hybrid imaging provides complementary information on the presence and localization of atherosclerotic lesions and myocardial perfusion abnormalities in symptomatic patients with previous CABG.
冠状动脉旁路移植术后（CABG）后反复发作的胸痛带来了诊断挑战。我们假设，结合旁路移植血管和原生冠状动脉解剖结构以及通过混合成像检测缺血情况，可在 CABG 后出现复发症状的患者中获得有价值且互补的信息。
我们分析了 36 例连续患者（67±9 岁，81%为男性），这些患者因 CABG 后反复发作症状而接受了冠状动脉计算机断层扫描血管造影（CCTA）和[15O]H2O 正电子发射断层扫描（PET）心肌灌注成像的混合成像。对冠状动脉树和左心室心肌进行了 3 个主要区域的划分，在 36 例患者中共产生了 108 个冠状动脉区域。通过 CCTA 评估阻塞性（≥50%）狭窄的存在和移植物的通畅性，通过定量腺苷应激 PET 评估心肌缺血情况。36 例研究患者中共有 28 例（78%）出现匹配的 PET/CCTA 异常。41 个冠状动脉区域由未阻塞的旁路移植血管或原生冠状动脉供应（保护区域）。然而，其中 12 个（29%）区域出现了灌注缺陷。在 6 例情况下，通过 PET/CCTA 融合图像，可解释在移植物冠状动脉吻合口远端的心肌存在灌注缺陷。反过来，在 CCTA 上有 48 个冠状动脉区域的供应动脉阻塞（非保护区域）。其中，41 个（85%，P<0.001 与保护区域相比）区域出现异常灌注，其中 29 例涉及吻合口远端的心肌。
混合成像为有症状的 CABG 后患者提供了关于动脉粥样硬化病变的存在和定位以及心肌灌注异常的补充信息。
