Pre-operative ischaemia on CMR stress perfusion is a marker for prolonged post-operative stay after coronary artery bypa
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BioMed Central
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Oral presentation
Pre-operative ischaemia on CMR stress perfusion is a marker for prolonged post-operative stay after coronary artery bypass grafting Joyce Wong*1, Anthony Mathur2, Peter G Mills2, Redha Boubertakh1, Rakesh Uppal2, Alan Wood3, Mark Westwood1 and LCeri Davies1 Address: 1CMR Dept, London Chest Hospital, Barts and the London NHS Trust, London, UK, 2London Chest Hospital, Barts and the London NHS Trust, London, UK and 3St Bartholomew's Hospital, Barts and the London NHS Trust, London, UK * Corresponding author
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010 Published: 21 January 2010 Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):O39
doi:10.1186/1532-429X-12-S1-O39
Abstracts of the 13th Annual SCMR Scientific Sessions - 2010
Meeting abstracts - A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-infoThis abstract is available from: http://jcmr-online.com/content/12/S1/O39 © 2010 Wong et al; licensee BioMed Central Ltd.
Background
Results
Stress perfusion CMR accurately identifies inducible perfusion defects, but its role prior to coronary artery bypass surgery (CABG) is unclear. Similarly, late gadolinium enhancement (LGE) in CMR is well established in the identification of viability, but prognostic value postCABG is uncertain. Out of the 2600 stress perfusion studies performed at our centre from 2008-2009, early postoperative outcomes were assessed in 56 consecutive patients who had CABG following a CMR scan. 28 patients underwent adenosine stress perfusion imaging, while all 56 underwent LGE imaging.
Across the cohort, mean left ventricular (LV) end diastolic volumes (EVD) were increased at 204 ± 10 mls, with a low mean ejection fraction (EF) of 28 ± 2.5%. 24 patients out of 56 had LGE with 3 or more non-viable segments, and had a significantly longer post-operative stay (11.1 ± 1.2 vs 7.4 ± 0.6 days, p < 0.01), and more severe LV impairment and dilatation (EF 27 ± 2.0 vs 50 ± 3.5%, p < 0.01, EDV 242 ± 13 vs 161 ± 12 mls, p < 0.0001). This group were also more likely to have had an unstable presentation with an acute coronary syndrome (ACS) (16/24 vs 12/40, p < 0.008). Patients with 6 or more ischaemic segments on stress CMR perfusion imaging also had a longer post-operative stay (11.6 ± 2.0 n = 12 vs 6.8 ± 0.6 days p < 0.05, n = 17) but this group had no differences in EDV or EF.
Methods 56 patients (10 females, age 64 +/- 12 years) were imaged on a 1.5 Tesla MR Scanner (Philips Achieva, Best, Netherlands) within 2 months of cardiac catheterisation demonstrating significant multivessel disease, prior to urgent or elective CABG. Adenosine (140 mcg/kg/min) was administered for 3 minutes to achieve myocardial hyperaemia following a standard CMR stress perfusion protocol, with single-bolus injection of gadoterate meglumine contrast (0.1 mmol/kg, Dotarem, Guerbet, SA). Early post-operative outcomes were assessed over a mean f
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