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Multimodality Cardiovascular Imaging in Patients After Coronary Artery Bypass Grafting: Diagnosis and Risk
Lucia La Mura1, Annalisa Pasquini2, Adriana D Antonio1
1Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy.
Insights
Optimizing post-coronary artery bypass grafting (CABG) care relies on multimodality cardiovascular imaging. This approach aids in assessing graft patency, detecting disease progression, and guiding patient management for improved long-term outcomes.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Coronary artery bypass grafting (CABG) is vital for advanced coronary artery disease.
- Long-term CABG success depends on graft patency, disease progression, and ventricular remodeling.
- Structured follow-up using multimodality imaging is crucial for post-CABG patients.
Purpose of the Study:
- To provide updated guidance on multimodality cardiovascular imaging in post-CABG patients.
- To establish a practical, evidence-based framework for optimizing outcomes after CABG.
- To highlight the role of various imaging modalities in evaluating and managing post-CABG patients.
Main Methods:
- Review of echocardiography, coronary computed tomography angiography (CCTA), cardiovascular magnetic resonance (CMR), and nuclear imaging (SPECT, PET).
- Emphasis on advanced techniques like strain imaging, FFR-CT, and hybrid PET/CT.
- Tailoring imaging strategies based on patient characteristics, symptoms, and pre-test probability.
Main Results:
- Echocardiography assesses ventricular function and valvular competence.
- CCTA evaluates graft patency and native coronary anatomy.
- CMR offers tissue characterization and ischemia assessment.
- Nuclear imaging quantifies perfusion and viability.
- Advanced imaging techniques enhance diagnostic accuracy and prognostic value.
Conclusions:
- Multimodality imaging is central to optimizing post-CABG patient care.
- Imaging strategies should be individualized for surveillance or diagnosis and intervention.
- This review offers a framework for evidence-based management of post-CABG patients.
Abstract:
Coronary artery bypass grafting (CABG) remains a cornerstone of treatment for patients with advanced or complex coronary artery disease, yet long-term success is influenced by graft patency, progression of native disease, and ventricular remodeling. Optimizing the follow-up of these patients requires a structured approach in which multimodality cardiovascular imaging plays a central role. Echocardiography remains the first-line modality, providing readily available assessment of ventricular function, valvular competence, and wall motion, while advanced techniques, such as strain imaging and myocardial work, enhance sensitivity for subclinical dysfunction. Coronary computed tomography angiography (CCTA) offers excellent diagnostic accuracy for graft patency and native coronary anatomy, with emerging applications of CT perfusion and fractional flow reserve derived from CT (FFR-CT) expanding its ability to assess lesion-specific ischemia. Cardiovascular magnetic resonance (CMR) provides comprehensive tissue characterization, quantifying scar burden, viability, and inducible ischemia, and stress CMR protocols have demonstrated both safety and independent prognostic value in post-CABG cohorts. Nuclear imaging with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) remains essential for quantifying perfusion, viability, and absolute myocardial blood flow, with hybrid PET/CT approaches offering further refinement in patients with recurrent symptoms. In patients after CABG, multimodality imaging is tailored to the patient's characteristics, symptoms, and pre-test probability of disease progression. In asymptomatic patients, imaging focuses on surveillance, risk stratification, and the early detection of subclinical abnormalities, whereas in symptomatic individuals, it focuses on establishing the diagnosis, defining prognosis, and guiding therapeutic interventions. Therefore, the aim of our review is to propose updated and comprehensive guidance on the crucial role of multimodality cardiovascular imaging in the evaluation and management of post-CABG patients and to provide a practical, evidence-based framework for optimizing outcomes.
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