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Updated: May 19, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Utility of nuclear stress imaging for detecting coronary artery bypass graft disease
Basel Al Aloul1, Mackenzi Mbai, Selcuk Adabag
1University of Minnesota, Minneapolis, MN, USA. baselaloul@hotmail.com
Insights
Single photon emission computed tomography stress myocardial perfusion imaging (SPECT-MPI) effectively detects graft disease one year after coronary artery bypass grafting (CABG) in unselected patients when optimal stress conditions are met.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Surgical Outcomes
Background:
- The diagnostic value of SPECT-MPI for graft disease post-CABG remains understudied in unselected patient cohorts.
- Prospective evaluation is needed to establish its role in routine clinical practice.
Purpose of the Study:
- To prospectively evaluate the accuracy of SPECT-MPI in detecting graft disease one year after CABG.
- To compare the performance of SPECT-MPI using different stress protocols.
Main Methods:
- The study involved 79 patients undergoing SPECT-MPI within 24 hours of coronary angiography, one year post-CABG.
- Stress protocols included symptom-limited exercise tests or adenosine infusion.
- SPECT-MPI results were compared to angiographic findings of graft stenosis (≥70%).
Main Results:
- Significant stenosis was found in 48% of patients and 22% of grafts.
- SPECT-MPI demonstrated 77% sensitivity, 69% specificity, and 73% accuracy with optimal exercise stress.
- Adenosine stress yielded 75% sensitivity, 57% specificity, and 64% accuracy.
Conclusions:
- SPECT-MPI shows good sensitivity and accuracy for detecting graft disease one year post-CABG in unselected patients.
- Optimal stress conditions are crucial for achieving reliable SPECT-MPI results in this setting.
Background:
The value of single photon emission computed tomography stress myocardial perfusion imaging (SPECT-MPI) for detecting graft disease after coronary artery bypass surgery (CABG) has not been studied prospectively in an unselected cohort.
Methods:
Radial Artery Versus Saphenous Vein Graft Study is a Veterans Affairs Cooperative Study to determine graft patency rates after CABG surgery. Seventy-nine participants agreed to SPECT-MPI within 24 hours of their coronary angiogram, one-year after CABG. The choice of the stress protocol was made at the discretion of the nuclear radiologist and was either a symptom-limited exercise test (n = 68) or an adenosine infusion (n = 11). The SPECT-MPI results were interpreted independent of the angiographic results and estimates of sensitivity, specificity and accuracy were based on the prediction of a graft stenosis of ≥70% on coronary angiogram.
Results:
A significant stenosis was present in 38 (48%) of 79 patients and 56 (22%) of 251 grafts. In those stress tests with an optimal exercise heart rate response (>80% maximum predicted heart rate) (n = 26) sensitivity, specificity and accuracy of SPECT-MPI for predicting the graft stenosis was 77%, 69% and 73% respectively. With adenosine (n = 11) it was 75%, 57% and 64%, respectively. Among participants with a suboptimal exercise heart rate response, the sensitivity of SPECT-MPI for predicting a graft stenosis was <50%. The accuracy of SPECT-MPI for detecting graft disease did not vary significantly with ischemic territory.
Conclusions:
Under optimal stress conditions, SPECT-MPI has a good sensitivity and accuracy for detecting graft disease in an unselected patient population 1 year post-CABG.
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