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Updated: Aug 14, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Quantitative Myocardial Perfusion Predicts Outcomes in Patients With Prior Surgical Revascularization
Andreas Seraphim1, Benjamin Dowsing2, Krishnaraj S Rathod2
1Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom. Electronic address: https://twitter.com/andreas_sera.
Insights
Quantitative myocardial perfusion indices, including global stress myocardial blood flow (MBF) and perfusion reserve (MPR) from cardiac magnetic resonance (CMR), independently predict adverse outcomes in patients with prior coronary artery bypass graft (CABG) surgery.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Disease
Background:
- Patients with prior coronary artery bypass graft (CABG) surgery often have complex coronary artery disease.
- These patients face a high risk of adverse cardiovascular events.
- Prognostic value of quantitative myocardial perfusion indices in this population is not well-established.
Purpose of the Study:
- To evaluate if global stress myocardial blood flow (MBF) and perfusion reserve (MPR) from perfusion mapping cardiac magnetic resonance (CMR) predict adverse outcomes in patients with prior CABG.
- To determine if these quantitative indices offer independent prognostic information beyond traditional risk factors.
Main Methods:
- Retrospective analysis of 341 patients with prior CABG undergoing adenosine stress perfusion CMR.
- In-line perfusion mapping with automated quantification of MBF and MPR.
- Primary outcome: composite of all-cause mortality and major adverse cardiovascular events (MACE).
- Cox proportional hazards models used for analysis, adjusting for comorbidities and CMR parameters.
Main Results:
- A total of 341 patients were analyzed (67 years median age, 86% male).
- During a median follow-up of 638 days, 24% experienced the primary outcome.
- Both stress MBF and MPR independently predicted outcomes after adjustment.
- Adjusted Hazard Ratios: 2.56 for a 1 mL/g/min decrease in stress MBF; 1.61 for a 1 unit decrease in MPR.
Conclusions:
- Global stress MBF and MPR derived from perfusion CMR are independent predictors of adverse outcomes in patients with prior CABG.
- These findings hold true irrespective of visual assessment of regional ischemia or extent of prior infarction.
Background:
Patients with previous coronary artery bypass graft (CABG) surgery typically have complex coronary disease and remain at high risk of adverse events. Quantitative myocardial perfusion indices predict outcomes in native vessel disease, but their prognostic performance in patients with prior CABG is unknown.
Objectives:
In this study, we sought to evaluate whether global stress myocardial blood flow (MBF) and perfusion reserve (MPR) derived from perfusion mapping cardiac magnetic resonance (CMR) independently predict adverse outcomes in patients with prior CABG.
Methods:
This was a retrospective analysis of consecutive patients with prior CABG referred for adenosine stress perfusion CMR. Perfusion mapping was performed in-line with automated quantification of MBF. The primary outcome was a composite of all-cause mortality and major adverse cardiovascular events defined as nonfatal myocardial infarction and unplanned revascularization. Associations were evaluated with the use of Cox proportional hazards models after adjusting for comorbidities and CMR parameters.
Results:
A total of 341 patients (median age 67 years, 86% male) were included. Over a median follow-up of 638 days (IQR: 367-976 days), 81 patients (24%) reached the primary outcome. Both stress MBF and MPR independently predicted outcomes after adjusting for known prognostic factors (regional ischemia, infarction). The adjusted hazard ratio (HR) for 1 mL/g/min of decrease in stress MBF was 2.56 (95% CI: 1.45-4.35) and for 1 unit of decrease in MPR was 1.61 (95% CI: 1.08-2.38).
Conclusions:
Global stress MBF and MPR derived from perfusion CMR independently predict adverse outcomes in patients with previous CABG. This effect is independent from the presence of regional ischemia on visual assessment and the extent of previous infarction.
