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Myocardial Viability by Cardiac Magnetic Resonance Imaging Before Coronary Artery Bypass Grafting
Brandon Peine1, Taha Lodhi2, Soban Ahmad3
1Division of Cardiac Surgery, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
Insights
Cardiac magnetic resonance imaging (CMR) assessment of myocardial viability does not predict outcomes in ischemic cardiomyopathy patients undergoing coronary artery bypass grafting (CABG). Nonviable tissue should not preclude CABG in suitable candidates.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Surgery
Background:
- The predictive value of myocardial viability assessed by cardiac magnetic resonance imaging (CMR) in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) remains uncertain.
- Previous studies using other assessment modalities have not established a correlation between myocardial viability and post-CABG survival.
Purpose of the Study:
- To evaluate the predictive value of CMR-assessed myocardial viability for left ventricular functional improvement and long-term survival in patients with ischemic cardiomyopathy undergoing isolated CABG.
- To determine if the extent of myocardial fibrosis in the left anterior descending artery territory influences outcomes after CABG.
Main Methods:
- Retrospective analysis of 106 patients with ischemic cardiomyopathy who underwent isolated CABG and preoperative CMR viability assessment between 2014 and 2022.
- Patients were stratified into three groups based on left anterior descending artery territory fibrosis: 0%, 25%-50%, and 75%-100%.
- Primary outcomes included postoperative improvement in left ventricular ejection fraction and 3-year survival, with analyses adjusted for The Society of Thoracic Surgeons Predicted Risk of Morbidity or Mortality scores.
Main Results:
- No significant differences in preoperative or operative factors were observed among the three viability groups.
- Left ventricular ejection fraction improvement rates were similar across groups (60.3% in 0% fibrosis, 79.0% in 25%-50% fibrosis, 57.1% in 75%-100% fibrosis), with no statistically significant differences after adjustment.
- Kaplan-Meier analysis revealed no significant differences in 3-year patient survival among the groups.
Conclusions:
- Myocardial viability assessment by CMR does not reliably predict left ventricular functional improvement or 3-year survival in patients with ischemic cardiomyopathy undergoing CABG.
- The presence of nonviable myocardium in the left anterior descending artery territory, as assessed by CMR, should not be an absolute contraindication for CABG in appropriately selected surgical candidates.
Background:
The predictive value of myocardial viability assessed by cardiac magnetic resonance imaging (CMR) in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) is uncertain. Other assessment modalities have not shown a correlation between viability and post-CABG survival.
Methods:
Patients from a single institution between 2014 and 2022 with ischemic cardiomyopathy who were undergoing isolated CABG and who had preoperative CMR viability assessment were included. Patients were grouped by left anterior descending artery territory viability: 0% fibrosis, 25% to 50% fibrosis, and 75% to 100% fibrosis. Primary outcomes were postoperative improvement in left ventricular ejection fraction and 3-year survival. Analyses were adjusted for The Society of Thoracic Surgeons Predicted Risk of Morbidity or Mortality scores.
Results:
A total of 106 patients met inclusion criteria, and they were divided into 3 groups by myocardial viability. There were no significant differences in preoperative or operative factors among the groups. Left ventricular ejection fraction improvement was seen in 60.3% of patients in the viable without fibrosis group, 79.0% of patients in the viable with fibrosis group, and 57.1% of patients in the nonviable group. Adjusted odds ratios of ejection fraction improvement among the groups demonstrated no significant differences. Similarly, there were no differences in patient survival by 3 years after CABG on Kaplan-Meier analysis.
Conclusions:
Myocardial viability assessment by CMR for patients with ischemic cardiomyopathy who are undergoing surgical revascularization does not predict left ventricular functional improvement or 3-year survival. Our data suggest that nonviable left anterior descending artery territory as assessed by CMR should not be a contraindication to CABG in otherwise appropriate surgical candidates.
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