Prediction of Improvement of Myocardial Wall Motion after Coronary Artery Bypass Surgery Using Rest T1-201/Dipyridamole Stress Gated Tc-99m-MIBI/24 Hour Delay T1-201 SPECT

Lee, Dong Soo; Lee, Won Woo; Yeo, Jeong Seok; Kim, Seok Ki; Kim, Ki Bong; Chung, June Key; Lee, Myung Chul

Abstract

PURPOSE: Using rest T1-201/dipyridamole stress Tc-99m-MIBI/24 hour T1-201 SPECT, we investigated the predictive values of the markers of the stress-rest reversibility (Rev), T1-201 rest perfusion (Rest), T1-201 24 hour redistribution (Del) and Tc-99m-MIBI gated systolic thickening (Thk) for wall motion improvement after coronary artery bypass surgery.
MATERIALS AND METHODS
In 39 patients (M:F=34:5, age 58+/-8), preoperative and postoperative (3 months) SPECT were compared. 24 hour delayed SPECT was done in 16 patients having perfusion defects at rest. Perfusion or wall motion was scored from 0 to 3 (0:normal to 3:defect or dyskinesia). Wall motion was abnormal in 142 segments among 585 segments of 99 artery territories which were surgically revascularized.
RESULTS
After bypass surgery, ejection fraction increased from 37.8+/-9.0% to 45.5+/-12.3% in 22 patients who had decreased ejection fraction preoperatively. Wall motion improved in 103 (72.5%) segments among 142 dysfunctional segments. Positive predictive values (PPV) of Rev, Rest, Del, and Thk were 83%, 76%, 43%, and 69% respectively. Negative predictive values (NPV) of Rev, Rest, Del, and Thk were 48%, 44%, 58%, and 21%, respectively. Rest/gated stress/delay SPECT had PPV of 74% and NPV of 46%. Though univariate logistic regression analysis revealed Rev (p=0.0008) and Rest (p=0.024) as significant predictors, stepwise multivariate test found Rev as the only good predictor (p=0.0008).
CONCLUSION
Among independent predictors obtained by rest T1-201/stress gated Tc-99m-MIBI/delayed T1-201 myocardial SPECT for wall motion improvement after bypass surgery, stress-rest reversibility was the single most useful predictor.