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

Korosoglou, Grigorios; Haars, Andreas; Michael, Gick; Erbacher, Markus; Hardt, Stefan; Giannitsis, Evangelos; Kurz, Kerstin; Franz-Josef, Neumann; Dickhaus, Helmut; A. Katus, Hugo; Kuecherer, Helmut

doi:10.1016/j.ahj.2006.12.019

« Previous Next »American Heart Journal
Volume 153, Issue 4 , Pages 612-620, April 2007

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

This paper was presented in part at the American Heart Association meeting in Dallas, November 2005.

Grigorios Korosoglou, MD
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- Reprint requests: Grigorios Korosoglou, MD, Johns Hopkins University Medical School, Department of Radiology; JHOC 4240, 601 North Caroline St, Baltimore, MD, 21287.
Andreas Haars, MD
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Gick Michael, MD
- Herzzentrum, Bad-Krozingen, Germany
Markus Erbacher, PhD
- Department of Medical Informatics, University of Heidelberg, Heidelberg, Germany
Stefan Hardt, MD
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Evangelos Giannitsis, MD
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Kerstin Kurz, MD
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Neumann Franz-Josef, MD
- Herzzentrum, Bad-Krozingen, Germany
Helmut Dickhaus, PhD
- Department of Medical Informatics, University of Heidelberg, Heidelberg, Germany
Hugo A. Katus, MD
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
Helmut Kuecherer, MD
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany

Received 20 July 2006; accepted 27 December 2006. published online 06 March 2007.

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.