Abstract
Background: Vasodilator stress echocardiography is a non-invasive tool which allows a detailed evaluation of coronary flow reserve integrated with myocardial wall motion analysis. In the present study we aimed to evaluate the value of velocity vector imaging (VVI) –based strain imaging, combined with dipyridamole stress echocardiography for assessment of left internal mammarian artery (LIMA) graft patency in patients who underwent robotic-assisted coronary artery bypass graft (CABG) surgery. Methods: We studied 40 patients (age 59.25±9.61 years, 58% male) who had robotic-assisted CABG surgery for LIMA-left anterior descending (LAD) artery and scheduled for coronary angiography. VVI-based strain echocardiography combined with dipyridamole stress echocardiography was performed. Left ventricular (LV) myocardial motion was evaluated using global strain and strain rate measurements. Additionally, Doppler evaluation of flow reserve of each LIMA graft were assessed. Results: Echocardiographic findings were compared with angiographic data. Among 40 patients only 7 had graft stenosis, based on angiography. We observed fair agreement between VVI combined stress echocardiography results and identification of 50%-100% LIMA stenosis. Impairment in LV global strain and strain rate values at peak dose dipyridamole predicted LIMA graft patency (p=0.02 for strain and p=0.0001 for strain rate). The average coronary flow reserve (CFR) value of all the LIMA grafts was 1.28±0.55. The agreement between CFR value and graft patency did not reach statistical significance (p=0.307). Conclusions: An integrated assessment of LV wall motion and flow reserve of LIMA graft in patients who underwent robotic-assisted CABG surgery is an accurate approach for identifying graft stenosis. This combined technique provides a useful tool for the non-invasive determination of LIMA graft patency, after CABG operation.
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