Quantitative evaluation of myocardial blush to assess tissue level reperfusion in patients with acute ST-elevation myocardial infarction - Incremental prognostic value compared with visual assessment
ABSTRACT Tissue level reperfusion gauges functional recovery in acute ischemic syndromes. However, its current clinical assessment is based upon visual interpretation of myocardial blush grade (MBG), which is operator dependent. The purpose of the study was to test whether quantification of MBG can enhance the predictive value of visual assessment for functional recovery in patients with acute ST-elevation myocardial infarction (STEMI).
Myocardial blush grade was assessed in 124 consecutive patients with STEMI visually and quantitatively, analyzing the time course of blush intensity rise. We defined Gmax as the peak gray level intensity and Tmax as the time to peak intensity. Ejection fraction >50% at 4 to 6 months of follow-up was deemed as the primary end point for assessment of successful tissue reperfusion.
Ejection fraction >50% at follow-up was predicted by visual MBG with moderate sensitivity (65%) and specificity (64%). However, a cutoff value of Gmax/Tmax = 3.1/s yielded significantly higher sensitivity and specificity (91% and 96%, respectively, for both P < .01). Gmax/Tmax was the most powerful predictor of follow-up ejection fraction >50% (relative risk of 4.6 vs 3.2 for visual MBG).
Quantitative MBG is highly predictive for functional recovery in patients with STEMI and provides incremental prognostic value to visual assessment. Thus, this simple approach may be used to gauge reperfusion strategies in acute ischemic syndromes.
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ABSTRACT: Myocardial perfusion is an important prognostic factor after recanalisation in acute myocardial infarction patients. We present a computerized, densitometric measurement method to assess myocardial perfusion on phase-matched digitally subtracted coronary angiograms. Quantitative myocardial perfusion was assessed by the G(max)/T(max) parameter of the time-density curves (TDCs) in infarct-related myocardial regions on X-ray coronary angiograms. Arteries were masked out from regions of measurement. This novel method has been compared with enzymatic infarct size, ST-segment resolution, and ejection fraction after successful revascularization of 62 patients with acute myocardial infarction. Significant correlations were found between G(max)/T(max) and enzymatic infarct size (R=-0.445, P<.001), ST-segment resolution (R=0.364, P=.004), and ejection fraction (R=0.278, P=.029). Bland and Altman plot of G(max)/T(max) reveals good interobserver agreement. G(max)/T(max) of the TDC measured in the infarct-related myocardial area is a reliable parameter to assess clinical indicators of myocardial reperfusion. Therefore, results suggest that it could be used to immediately assess the success of recanalisation at the tissue perfusion level during coronary intervention, and as an objective end point in clinical trials of new interventional devices and drugs.Cardiovascular revascularization medicine: including molecular interventions 01/2009; 10(1):49-54. DOI:10.1016/j.carrev.2008.10.001
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