Improved wall motion of late gadolinium-enhanced myocardium after complete surgical revascularization.

Abstract

Gadolinium-enhanced cardiac magnetic resonance (CMR) imaging suggests a low possibility of myocardial function improvement after revascularization if the transmural extent of late gadolinium enhancement (LGE) was over 50%. We evaluated myocardial wall motion in patients who underwent complete revascularization for left ventricular dysfunction. Thirty-three patients with left ventricular dysfunction (ejection fraction ≤ 0.35) underwent complete revascularization. Gadolinium-enhanced CMR was performed preoperatively and postoperatively (postoperative 24.1 ± 17.6 months). Postoperative coronary angiograms were also performed to confirm graft patency. Wall motion score and transmural extent of LGE were evaluated on a 16 segment model of short-axis images. Of 528 total segments, 373 dysfunctional segments (70.6%; 189 hypokinesia, 177 akinesia, 6 dyskinesia, and 1 aneurysm) were evaluated for postoperative changes. When LGE was graded on a 5 point scale (absence of LGE, grade 0; LGE of 1% to 25%, grade 1; 26% to 50%, grade 2; 51% to 75%, grade 3; and 76% to 100%, grade 4), LGE was found in 221 (59%) segments (grades 1, n = 80; 2, n = 55; 3, n = 37; and 4, n = 49). After revascularization, wall motion improved in 72.1% (269 of 373) of dysfunctional segments (128 of 189 hypokinesia versus 141 of 184 akinesia; p = 0.055). Improved wall motion was observed in 77.0% (117 of 152), 67.5% (54 of 80), 69.1% (38 of 55), 86.5% (32 of 37), and 57.1% (28 of 49) of grades 0, 1, 2, 3, and 4 segments, respectively. Improved motion of late gadolinium-enhanced myocardium, even in segments showing transmural LGE of 75% or greater and akinesia, was observed after complete revascularization. An inverse proportional correlation between the transmural extent of LGE and wall motion improvement was not observed.