Abstract
Background:Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST‐segment reduction are indices of myocardial reperfusion.
Hypothesis: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).
Methods: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 ≥ 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.
Results: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 ≥ 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 ≥ 2 showed the better negative likelihood ratio, and ST‐segment elevation index reduction had the higher positive likelihood ratio in predicting LV function recovery.
Conclusions:Myocardial blush grade was the best parameter for prediction of LV function recovery: MBG ≥ 2 and ST‐segment elevation index reduction showed good accuracy in predicting LV function recovery. The cTFC failed to be a significant predictor.
Keywords: acute myocardial infarction, gated tomography, primary coronary angioplasty
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References
- 1. Ito H, Tomooka T, Sakai N, Higashino Y, Fujii K, Masuyama T, Kitabatake A, Minamino T: Lack of myocardial perfusion immediately after successful thrombolysis. A predictor of poor recovery of left ventricular function in anterior myocardial infarction. Circulation 1992; 85: 1699–1705 [DOI] [PubMed] [Google Scholar]
- 2. Bax M, de Winter RJ, Schotborgh CE, Koch KT, Meuwissen M, Voskuil M, Adams R, Mulder KJ, Tijssen JG, Piek JJ: Short and long‐term recovery of left ventricular function predicted at the time of primary percutaneous coronary intervention in anterior myocardial infarction. J Am Coll Cardiol 2004; 43: 534–541 [DOI] [PubMed] [Google Scholar]
- 3. Kondo M, Nakano A, Saito D, Shimono Y: Assessment of “microvascular no‐reflow phenomenon” using technetium–99m macroaggregated albumin scintigraphy in patients with acute myocardial infarction. J Am Coll Cardiol 1998; 32: 898–903 [DOI] [PubMed] [Google Scholar]
- 4. Bremerich J, Wendland MF, Arheden H, Wyttenbach R, Gao DW, Huberty JP, Dae MW, Higgins CB, Saeed M: Microvascular injury in reperfused in‐farcted myocardium: Noninvasive assessment with contrast‐enhanced echo‐planar magnetic resonance imaging. J Am Coll Cardiol 1998; 32: 787–793 [DOI] [PubMed] [Google Scholar]
- 5. Santoro GM, Valenti R, Buonamici P, Bolognese L, Cerisano G, Moschi G, Trapani M, Antoniucci D, Fazzini PF: Relation between ST‐segment changes and myocardial perfusion evaluated by myocardial contrast echocardiography in patients with acute myocardial infarction treated with direct angioplasty. Am J Cardiol 1998; 82: 932–937 [DOI] [PubMed] [Google Scholar]
- 6. Poli A, Fetiveau R, Vandoni P, del Rosso G, D'Urbano M, Seveso G, Cafiero F, De Servi S: Integrated analysis of myocardial blush and ST‐segment elevation recovery after successful primary angioplasty: Real‐time grading of microvascular reperfusion and prediction of early and late recovery of left ventricular function. Circulation 2002; 106: 313–318 [DOI] [PubMed] [Google Scholar]
- 7. van't Hof AW, Liem A, Suryapranata H, Hoorntje JC, deBoer MJ, Zijlstra F: Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: Myocardial blush grade. Zwolle Myocardial Infarction Study Group. Circulation 1998; 97: 2302–2306 [DOI] [PubMed] [Google Scholar]
- 8. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E: TIMI frame count: A quantitative method of assessing coronary artery flow. Circulation 1996; 93: 879–888 [DOI] [PubMed] [Google Scholar]
- 9. Schomig A, Kastrati A, Dirschinger J, Mehilli J, Schricke U, Pache J, Martin‐off S, Neumann FJ, Schwaiger M: Coronary stenting plus platelet glycoprotein IIb/IIIa blockade compared with tissue plasminogen activator in acute myocardial infarction. Stent versus Thrombolysis for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Study Investigators. N Engl J Med 2000; 343: 385–391 [DOI] [PubMed] [Google Scholar]
- 10. Germano G, Erel J, Lewin H, Kavanagh PB, Berman DS: Automatic quantification of regional myocardial wall motion and thickening from gated technetium–99m sestamibi myocardial perfusion single‐photon emission computed tomography. J Am Coll Cardiol 1997; 30: 1360–1367 [DOI] [PubMed] [Google Scholar]
- 11. The TIMI Study Group . The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 1985; 312: 932–936 [DOI] [PubMed] [Google Scholar]
- 12. Angeja BG, Gunda M, Murphy SA, Sobel BE, Rundle AC, Syed M, Asfour A, Borzak S, Gourlay SG, Barron HV, Gibbons RJ, Gibson CM: TIMI myocardial perfusion grade and ST‐segment resolution: Association with infarct size as assessed by single photon emission computed tomography imaging. Circulation 2002; 105: 282–285 [DOI] [PubMed] [Google Scholar]
- 13. Hamada S, Nishiue T, Nakamura S, Sugiura T, Kamihata H, Miyoshi H, Imuro Y, Iwasaka T: TIMI frame count immediately after primary coronary angioplasty as a predictor of functional recovery in patients with TIMI 3 reperfused acute myocardial infarction. J Am Coll Cardiol 2001; 38: 666–671 [DOI] [PubMed] [Google Scholar]
- 14. Dibra A, Mehilli J, Dirschinger J, Pache J, Neverve J, Schwaiger M, Schomig A, Kastrati A: Thrombolysis In Myocardial Infarction myocardial perfusion grade in angiography correlates with myocardial salvage in patients with acute myocardial infarction treated with stenting or thrombolysis. JAm Coll Cardiol 2003; 41: 925–929 [DOI] [PubMed] [Google Scholar]
- 15. Dong J, Ndrepepa G, Schmitt C, Mehilli J, Schmieder S, Schwaiger M, Schomig A, Kastrati A: Early resolution of ST‐segment elevation correlates with myocardial salvage assessed by Tc‐99m sestamibi scintigraphy in patients with acute myocardial infarction after mechanical or thrombolytic reperfusion therapy. Circulation 2002; 105: 2946–2949 [DOI] [PubMed] [Google Scholar]
- 16. Haager PK, Christott P, Heussen N, Lepper W, Hanrath P, Hoffmann R: Prediction of clinical outcome after mechanical revascularization in acute myocardial infarction by markers of myocardial reperfusion. J Am Coll Cardiol 2003; 41: 532–538 [DOI] [PubMed] [Google Scholar]