Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy.
Clinical Cardiology (Impact Factor: 2.59). 12/2004; 27(12):683-8. DOI: 10.1002/clc.4960271205
Source: PubMed


Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion.
We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).
In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase > or = 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST-segment elevation index 1 h after PCI were determined to evaluate reperfusion.
Twenty-four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p = 0.0001), and ST-segment elevation index at 1 h (r = -0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST-segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade > or = 2 and ST-segment elevation index reduction had the same accuracy (88%) for predicting LV function recovery. Lower accuracy (75%) was shown by fast cTFC (< 23 frames). Myocardial blush grade > or = 2 showed the better negative likelihood ratio, and ST-segment elevation index reduction had the higher positive likelihood ratio in predicting LV function recovery.
Myocardial blush grade was the best parameter for prediction of LV function recovery: MBG > or = 2 and ST-segment elevation index reduction showed good accuracy in predicting LV function recovery. The cTFC failed to be a significant predictor.

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Available from: Mauro Maioli, Sep 22, 2014
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    • "Therefore, achieving a baseline TIMI flow of 3 along with a myocardial blush grade of 3 should be considered to indicate optimal reperfusion. This finding is in accordance with previous studies demonstrating a normal myocardial blush grade as a predictor of survival and left ventricular recovery in patients who undergo pPCI and rescue angioplasty (24-28). "
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    • "It correlates with ST-segment elevation index and an integrated analysis of both parameters allows an accurate assessment of myocardial perfusion [5]. It is one of the best parameters for assessment of the left ventricular function recovery [6]. Therefore, it is a good predictor for long-term mortality after angioplasty [7]. "
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    ABSTRACT: Despite recovering a normal coronary flow after acute myocardial infarction, percutaneous coronary intervention does not guarantee a proper perfusion (irrigation) of the infarcted area. This damage in microcirculation integrity may detrimentally affect the patient survival. Visual assessment of the myocardium opacification in contrast angiography serves to define a subjective score of the microcirculation integrity myocardial blush analysis (MBA). Although MBA correlates with patient prognosis its visual assessment is a very difficult task that requires of a highly expertise training in order to achieve a good intraobserver and interobserver agreement. In this paper, we provide objective descriptors of the myocardium staining pattern by analyzing the spectrum of the image local statistics. The descriptors proposed discriminate among the different phenomena observed in the angiographic sequence and allow defining an objective score of the myocardial perfusion.
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    ABSTRACT: Riassunto Premesse. L'angioplastica coronarica (PTCA) nel- l'infarto miocardio acuto (IMA) non sempre ot- tiene un'efficace riperfusione miocardica nono- stante la ricanalizzazione vascolare. Il presente studio si prefigge di esplorare, con particolare at- tenzione all'immediato post PTCA, i rapporti di NT-proBNP con variabili clinico diagnostiche pre/post procedura di impiego routinario e con riscontri angiografici di riperfusione microvasco- lare in funzione del recupero successivo della fun- zione contrattile miocardica. Materiali e Metodi. In 78 pazienti con IMA ante- riore e sopraslivellamento del tratto ST sottopo- sti a PTCA efficace sono stati misurati il parame- tro angiografico Myocardial Blush (MB) in corso di PTCA quale indice di presenza di microperfu- sione e NT-proBNP all'ingresso, a 48 ore, 7 gior- ni e a 6 mesi post procedura. I valori ecografici della frazione di eiezione ventricolare sx (FE) sono stati registrati agli stessi tempi e i parametri biochimici CK e c-TnT in basale e al picco. NT- proBNP, c-TnT e CK totale sono stati determi- nati su siero mediante analizzatore Modular PE, Roche Diagnostics, rispettivamente con tecnica ECLIA e con standardizzazione IFCC per CK. Risultati. Tranne che all'ingresso, in tutti gli altri momenti di osservazione le mediane di NT- proBNP si dimostrano significativamente inferiori nei pazienti con MB normale. All'analisi univariata sia NT-proBNP a 48 ore e a 7 giorni (OR 1.83, p = 0.004 e OR 1.62, p = 0.007, 95%CI rispettivamente) che MB sono inversamen- te correlati al recupero di FE a 6 mesi, ma MB evidenzia le migliori performance sia all'analisi univariata che multivariata. NT-proBNP a 7 giorni si correla con numerose variabili di importanza prognostica quali età, tempo di ischemia, n° vasi interessati, picco CK e c-TnT.
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