Thallium-201 myocardial imaging before and after coronary revascularization. Assessment of regional myocardial blood flow and graft patency

Abstract

Twenty patients underwent myocardial imaging with thallium-201 (201Tl) before and subsequent to coronary artery bypass grafting. All patients had rest and maximal treadmill exercise imaging postoperatively. Eleven of the 20 patients had rest and exercise 201Tl images preoperatively; 9/20 only had rest imaging preoperatively. Postoperative regional exercise perfusion was improved in 7 of the 11 patients who had preoperative exercise images, and was associated with regional graft patency in each case. Thirteen of 20 patients showed no new defect with postoperative exercise imaging. The remaining 7 patients developed or had an increased defect with exercise. The patients with no new perfusion defects during postoperative study had 26/30 grafts patent (87%). Patients developing a new perfusion defect with exercise had fewer grafts patent (7 of 13 [54%]; P < 0.03). In these 7 cases, a new exercise-induced defect was associated with regional graft closure or residual nonoperated disease. Knowledge of the preoperative coronary anatomy allowed the distinction between ungrafted areas and regional graft dysfunction. The authors conclude that preoperative and postoperative 201Tl imaging may noninvasively predict graft closure and/or improved regional perfusion with patent grafts.