Article

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

Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
American heart journal (Impact Factor: 4.56). 05/2007; 153(4):612-20. DOI: 10.1016/j.ahj.2006.12.019
Source: PubMed

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.

0 Followers
 · 
74 Views
  • Source
    [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate whether myocardial deformation imaging, assessed by feature tracking cardiac magnetic resonance (FTI-CMR), would allow objective quantification of myocardial strain and estimation of functional recovery in patients with first time ST-elevation myocardial infarction (STEMI). Cardiac magnetic resonance (CMR) imaging was performed in 74 consecutive patients 2-4days after successfully reperfused STEMI, using a 1.5T CMR scanner (Philips Achieva). Peak systolic circumferential and longitudinal strains were measured using the FTI applied to SSFP cine sequences and were compared to infarct size, determined by late gadolinium enhancement (LGE). Follow-up CMR at 6months was performed in order to assess residual ejection fraction, which deemed as the reference standard for the estimation of functional recovery. During the follow-up period 53 of 74 (72%) patients exhibited preserved residual ejection fraction ≥50%. A cut-off value of -19.3% for global circumferential strain identified patients with preserved ejection fraction ≥50% at follow-up with sensitivity of 76% and specificity of 85% (AUC=0.86, 95% CI=0.75-0.93, p<0.001), which was superior to that provided by longitudinal strain (ΔAUC=0.13, SE=0.05, z-statistic=2.5, p=0.01), and non-inferior to that provided by LGE (ΔAUC=0.07, p=NS). Multivariate analysis showed that global circumferential strain and LGE exhibited independent value for the prediction of preserved LV-function, surpassing that provided by age, diabetes and baseline ejection fraction (HR=1.4, 95% CI=1.0-1.9 and HR=1.4, 95% CI=1.1-1.7, respectively, p<0.05 for both). Estimation of circumferential strain by FTI provides objective assessment of infarct size without the need for contrast agent administration and estimation of functional recovery with non-inferior accuracy compared to that provided by LGE. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 01/2015; 183C:162-170. DOI:10.1016/j.ijcard.2015.01.022 · 6.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: X-ray angiography is widely used in cardiac disease diagnosis during or prior to intravascular interventions. The diaphragm motion and the heart beating induce gray-level changes, which are one of the main obstacles in quantitative analysis of myocardial perfusion. In this paper we focus on detecting the diaphragm border in both single images or whole X-ray angiography sequences. We show that the proposed method outperforms state of the art approaches. We extend a previous publicly available data set, adding new ground truth data. We also compose another set of more challenging images, thus having two separate data sets of increasing difficulty. Finally, we show three applications of our method: (1) a strategy to reduce false positives in vessel enhanced images; (2) a digital diaphragm removal algorithm; (3) an improvement in Myocardial Blush Grade semi-automatic estimation.
    Computerized medical imaging and graphics: the official journal of the Computerized Medical Imaging Society 06/2014; 38(4). DOI:10.1016/j.compmedimag.2014.01.003 · 1.50 Impact Factor