title: 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: 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.
authors: Department of Cardiology, University of Heidelberg, Heidelberg, Germany. gkorosoglou@hotmail.com
authors: Grigorios
authors: G
authors: Korosoglou
authors: Andreas
authors: A
authors: Haars
authors: Gick
authors: G
authors: Michael
authors: Markus
authors: M
authors: Erbacher
authors: Stefan
authors: S
authors: Hardt
authors: Evangelos
authors: E
authors: Giannitsis
authors: Kerstin
authors: K
authors: Kurz
authors: Neumann
authors: N
authors: Franz-Josef
authors: Helmut
authors: H
authors: Dickhaus
authors: Hugo A
authors: HA
authors: Katus
authors: Helmut
authors: H
authors: Kuecherer
mesh_terms: 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