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Nuclear imaging techniques in the assessment of myocardial perfusion and function after CABG: does it correlate with CK-MB elevation?
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Abstract
MATERIAL AND METHODS: 36 patients (age: 52.5 ± 8.5 years, 33M/3F) treated with CABG were prospectively studied. CK-MB level was assessed at 0, 4, 8, 12, 24, 36, 48 and 72 hours after surgery. MPI (SPECT using Tc-99m-MIBI) and RNV were performed 2 weeks before and 3–4 months after surgery. All patients had an uneventful hospitalisation. The subjects were divided into two groups: group 1 with CK-MB increase > 50 IU/ml (n = 9) and group 2 with CK-MB levels ≤ 50 IU/ml (n = 27). There was no difference between the groups regarding the number of diseased arteries, haemodynamic parameters, aortic clamping time or the number of grafts.
RESULTS: Perfusion improvement at stress and at rest was significantly lower in group 1 than in group 2. The ejection fraction did not change significantly in both groups (ΔEF = 0.6 ± 13.5 in group 1 v. 0.7 ± 9.7 in group 2, p = NS), however, in 5 patients from group 1 (56%) and in 6 patients from group 2 (22%) the EF decreased significantly at follow-up RNV (p = 0.05). In 6 patients (5 in group 1 and 1 in group 2) a new defect of perfusion was found at follow-up MPI. The sensitivity and specificity of increased CK-MB level in predicting perfusion deterioration were 83% and 87%, respectively.
CONCLUSIONS: We conclude that patients with an increased level of CK-MB isoenzyme (> 50 IU/ml) after coronary artery surgery have a higher rate of perfusion and function deterioration. The increase of CK-MB level early after coronary bypass surgery in patients without ECG markers of perioperative infarction indicates a probable ischaemic insult during surgery.
Abstract
MATERIAL AND METHODS: 36 patients (age: 52.5 ± 8.5 years, 33M/3F) treated with CABG were prospectively studied. CK-MB level was assessed at 0, 4, 8, 12, 24, 36, 48 and 72 hours after surgery. MPI (SPECT using Tc-99m-MIBI) and RNV were performed 2 weeks before and 3–4 months after surgery. All patients had an uneventful hospitalisation. The subjects were divided into two groups: group 1 with CK-MB increase > 50 IU/ml (n = 9) and group 2 with CK-MB levels ≤ 50 IU/ml (n = 27). There was no difference between the groups regarding the number of diseased arteries, haemodynamic parameters, aortic clamping time or the number of grafts.
RESULTS: Perfusion improvement at stress and at rest was significantly lower in group 1 than in group 2. The ejection fraction did not change significantly in both groups (ΔEF = 0.6 ± 13.5 in group 1 v. 0.7 ± 9.7 in group 2, p = NS), however, in 5 patients from group 1 (56%) and in 6 patients from group 2 (22%) the EF decreased significantly at follow-up RNV (p = 0.05). In 6 patients (5 in group 1 and 1 in group 2) a new defect of perfusion was found at follow-up MPI. The sensitivity and specificity of increased CK-MB level in predicting perfusion deterioration were 83% and 87%, respectively.
CONCLUSIONS: We conclude that patients with an increased level of CK-MB isoenzyme (> 50 IU/ml) after coronary artery surgery have a higher rate of perfusion and function deterioration. The increase of CK-MB level early after coronary bypass surgery in patients without ECG markers of perioperative infarction indicates a probable ischaemic insult during surgery.
Keywords
coronary artery bypass grafting; CK-MB isoenzyme; perioperative infarction; myocardial perfusion imaging; radionuclide ventriculography
Title
Nuclear imaging techniques in the assessment of myocardial perfusion and function after CABG: does it correlate with CK-MB elevation?
Journal
Issue
Pages
5-9
Published online
2003-01-03
Page views
545
Article views/downloads
1371
Bibliographic record
Nucl. Med. Rev 2003;6(1):5-9.
Keywords
coronary artery bypass grafting
CK-MB isoenzyme
perioperative infarction
myocardial perfusion imaging
radionuclide ventriculography
Authors
Paweł Kwinecki
Marek Jemielity
Rafał Czepczyński
Artur Baszko
Marek Ruchała
Jerzy Sowiński
Wojciech Dyszkiewicz