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(Circulation. 2004;110:1535-1541.)
© 2004 American Heart Association, Inc.

Cardiovascular Surgery

Value of Delayed-Enhancement Cardiovascular Magnetic Resonance Imaging in Predicting Myocardial Viability After Surgical Revascularization

Joseph B. Selvanayagam, MBBS, FRACP; Attila Kardos, MD, PhD; Jane M. Francis, DCRR, DNM; Frank Wiesmann, MD; Steffen E. Petersen, MD; David P. Taggart, MD, PhD; Stefan Neubauer, MD, FRCP

From the University of Oxford Centre for Clinical Magnetic Resonance Research (J.B.S., S.E.P., J.M.F., A.K., F.W., S.N.), and the Departments of Cardiovascular Medicine (J.B.S., S.E.P., J.M.F., A.K., F.W., S.N.) and Cardiothoracic Surgery (D.P.T.), University of Oxford, John Radcliffe Hospital, Oxford, UK.

Correspondence to Stefan Neubauer, MD, FRCP, Professor of Cardiovascular Medicine, Department of Cardiovascular Medicine, Level 5, John Radcliffe Hospital, Oxford, OX3 9DU, UK. E-mail stefan.neubauer{at}cardiov.ox.ac.uk

Received February 18, 2004; de novo received April 22, 2004; accepted May 18, 2004.

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.

Key Words: imaging • coronary disease • surgery • myocardium

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