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.
BACKGROUND
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).


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Korosoglou
Grigorios
G
Department of Cardiology, University of Heidelberg, Heidelberg, Germany. gkorosoglou@hotmail.com
Haars
Andreas
A
Michael
Gick
G
Erbacher
Markus
M
Hardt
Stefan
S
Giannitsis
Evangelos
E
Kurz
Kerstin
K
Franz-Josef
Neumann
N
Dickhaus
Helmut
H
Katus
Hugo A
HA
Kuecherer
Helmut
H
D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests / Q000379:methods; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015425:Myocardial Reperfusion; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D014463:Ultrasonography