Assessment of no-reflow phenomenon by myocardial blush grade and pulsed wave tissue doppler imaging in patients with acute coronary syndrome

Abstract

Background:No-reflow phenomenon is a complication of myocardial revascularization and it is associated with a worse prognosis.Materials and Methods:A prospective study was carried out enrolling patients with acute myocardial infarction (64 patients, 49 male and 15 female, median age 64.9 ± 10.61 years), both STEMI and NSTEMI, who underwent myocardial revascularization with percutaneous coronary intervention (PCI). TIMI flow and Myocardial Blush Grade (MBG) were assessed at baseline (T0), in addition to tissue Doppler imaging (TDI) and electrocardiogram. Cardiological evaluation was also performed at T1 (one month after PCI) and T2 (every year after revascularization for a mean follow-up of 24.9 months ± 6.93 months). Patients were divided into two groups on the basis of MBG.Results:In the present study, we found at T1 a significant association between MBG and dyslipidemia (P = 0,038) and NYHA class and MBG (P = 0,040), among clinical variables and cardiovascular risk factors. Moreover, a statistically significant relationship was observed between MBG and a new echocardiographic index of systolic and diastolic dysfunction, the EAS index measured with tissue Doppler imaging (P = 0,013). At T2, the EAS parameter was also significantly impaired in patients with reduced MBG, compared to patients with normal MBG (P = 0,003).Conclusions:This study demonstrates that the combined evaluation of systolic and diastolic dysfunction by EAS index, according to the literature, could detect a subclinical ventricular dysfunction due to a perfusion defect. Therefore, EAS index could be a useful parameter to be measured in the follow-up of patients undergoing revascularization.

Long-term outcome and prognostic value of angiographic slow/no-reflow phenomenon after emergency percutaneous coronary intervention for ST-elevation myocardial infarction

“…One of the limitations of the current study is the use of the TIMI grade flow system to assess coronary flow, which is characterized by subjectivity and classification and also has the potential for error, especially in cases involving TIMI grade 2 flow. Although the TIMI flow classification method has been used in most of the previous studies to identify CSF/NRP cases, some studies have also used other angiographic evaluation methods such as myocardial blush grade and TIMI frame count [22][23][24][25]. Additionally, our study is limited by the lack of systematic data with respect to infarct size, regional wall motion, and left ventricular remodeling in patients with AMI over the follow-up period.…”

«No-reflow» phenomenon and risk factors associated with its development after primary percutaneous coronary interventions in patients with ST elevation myocardial infarction

“…Як відомо з літературних джерел [13], зниження міокардіальної перфузії (MBG менше 3 балів) є доказом розвитку ФНК і предиктором несприятливого прогнозу. A.W.…”