{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T12:04:53Z","timestamp":1766405093441,"version":"3.48.0"},"reference-count":74,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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\u2019s 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.<\/jats:p>","DOI":"10.3390\/diagnostics15243224","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T09:43:46Z","timestamp":1765964626000},"page":"3224","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodality Cardiovascular Imaging in Patients After Coronary Artery Bypass Grafting: Diagnosis and Risk Stratification"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4648-0460","authenticated-orcid":false,"given":"Lucia","family":"La Mura","sequence":"first","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8015-6923","authenticated-orcid":false,"given":"Annalisa","family":"Pasquini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 20123 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6791-1656","authenticated-orcid":false,"given":"Adriana","family":"D\u2032Antonio","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples \u201cFederico II\u201d, 80131 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0464-3607","authenticated-orcid":false,"given":"Eirini","family":"Beneki","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Lausanne University Hospital and University of Lausanne, 1005 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1100-101X","authenticated-orcid":false,"given":"Irfan","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashot","family":"Avagimyan","sequence":"additional","affiliation":[{"name":"Internal Diseases Propedeutics Department, Yerevan State Medical University after M. Heratsi, Koryn 2a, Yerevan 0025, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Abdelnabi","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Department, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramzi","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine Department, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2021-1660","authenticated-orcid":false,"given":"Vikash","family":"Jaiswal","sequence":"additional","affiliation":[{"name":"Endeavor Center for Cardiovascular Intervention Outcomes Research and Evaluation (ECCORE), Section of Interventional Cardiology, Endeavor Health Cardiovascular Institute, Glenview, IL 60201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1418-7908","authenticated-orcid":false,"given":"Francesco","family":"Perone","sequence":"additional","affiliation":[{"name":"Cardiac Rehabilitation Unit, Rehabilitation Clinic \u201cVilla delle Magnolie\u201d, Castel Morrone, 81020 Caserta, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. 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