Myocardial Perfusion Grade After Late Infarct Artery Recanalization Is Associated With Global and Regional Left Ventricular Function at One Year

Steigen, Terje K.; Buller, Christopher E.; Mancini, G.B. John; Jorapur, Vinod; Cantor, Warren J.; Rankin, James M.; Thomas, Boban; Webb, John G.; Kronsberg, Shari S.; Atchison, Deborah J.; Lamas, Gervasio A.; Hochman, Judith S.; Džavík, Vladimir

doi:10.1161/circinterventions.109.918722

Cited by 9 publications

(9 citation statements)

References 33 publications

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“…Whether improving infarct perfusion is beneficial to infarct healing and preventing myocardial remodeling remains to be determined in future studies. However, higher perfusion of the infarct has been shown to be associated with better myocardial recovery at the long‐term stage . Moreover, meta‐analysis of percutaneous coronary intervention studies targeting totally occluded infarct‐related artery reported that restoring the coronary flow at an average of 10 days after an MI is associated with improved cardiac function and reduced LV remodeling in the long‐term stages .…”

Section: Discussionmentioning

confidence: 99%

“…However, higher perfusion of the infarct has been shown to be associated with better myocardial recovery at the long-term stage. 24 Moreover, meta-analysis of percutaneous coronary intervention studies targeting totally occluded infarct-related artery reported that restoring the coronary flow at an average of 10 days after an MI is associated with improved cardiac function and reduced LV remodeling in the long-term stages. 25 These data suggest that increasing the infarct perfusion with mechanical LV unloading may be favorable for treating recent MI.…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

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Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure

Watanabe

Fish

Kovacic

et al. 2018

JAHA

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BackgroundDelivering therapeutic materials, like stem cells or gene vectors, to the myocardium is difficult in the setting of ischemic heart failure because of decreased coronary flow and impaired microvascular perfusion (MP). The aim of this study was to determine if mechanical left ventricular (LV) unloading with the Impella increases coronary flow and MP in a subacute myocardial infarction.Methods and ResultsAnterior transmural myocardial infarction (infarct size, 26.0±3.4%) was induced in Yorkshire pigs. At 2 weeks after myocardial infarction, 6 animals underwent mechanical LV unloading by Impella, whereas 4 animals underwent pharmacological LV unloading using sodium nitroprusside for 2 hours. LV unloading with Impella significantly reduced end‐diastolic volume (−16±11mL, P=0.02) and end‐diastolic pressure (EDP; −32±23 mm Hg, P=0.03), resulting in a significant decrease in LV end‐diastolic wall stress (EDWS) (infarct: 71.6±14.7 to 43.3±10.8 kdynes/cm2 [P=0.02]; remote: 66.6±20.9 to 40.6±13.3 kdynes/cm2 [P=0.02]). Coronary flow increased immediately and remained elevated after 2 hours in Impella‐treated pigs. Compared with the baseline, MP measured by fluorescent microspheres significantly increased within the infarct zone (109±81%, P=0.003), but not in the remote zone. Although sodium nitroprusside effectively reduced LV‐EDWS, 2 (50%) of sodium nitroprusside–treated pigs developed profound systemic hypotension. A significant correlation was observed between the infarct MP and EDWS (r 2=0.43, P=0.03), suggesting an important role of EDWS in regulating MP during LV unloading in the infarcted myocardium.Conclusions LV unloading using an Impella decreased EDWS and increased infarct MP without hemodynamic decompensation. Mechanical LV unloading is a novel and efficient approach to increase infarct MP in patients with subacute myocardial infarction.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure

Watanabe

Fish

Kovacic

et al. 2018

JAHA

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“…It was not clear if the total blush was superior to the simple MPG. [ 1 ] Theoretically, the blush grade does not take into account the area of the blush. Therefore, the total blush should have been better.…”

Section: Discussionmentioning

confidence: 99%

“…The myocardial perfusion grade (MPG) is the measurement of coronary myocardial perfusion. [ 1 ] It primarily aims to quantify the increase in gray value over time. [ 2 ] The darker the myocardium, the better the perfusion is.…”

Section: Introductionmentioning

confidence: 99%

Calculation of Coronary Angiographic Total Blush in Patients with Coronary Artery Disease and its Prognostic Implication

Gai

Yan

et al. 2015

Chinese Medical Journal

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Background:Myocardial perfusion grade (MPG) is an accepted method of evaluating myocardial perfusion. However, it does not take into the account, the extent of the perfusion. We hypothesized that myocardial blush area times MPG (total blush) would be more accurate than simple MPG, and yield better prognostic information.Methods:About 34 patients were recruited after they had consented to both coronary angiography (CAG) and single photon emission computed tomography (SPECT), and divided into two groups. A special dedicated computer was employed to calculate the total blush. The CAG was performed as a conventional way. Scintigraphic technetium 99m methoxyisobutyl-isonitrile rest and stress images were evaluated quantitatively. The comparison was made between stenosis versus chronic total occlusion (CTO), MPG 1, 2 versus MPG 3, percutaneous intervention (PCI) successful versus failure. A correlation was made between ejection fraction (EF) and myocardial perfusion by MPG, total blush, SPECT, and syntax score.Results:The perfusion indices of total blush, summed difference score (SDS) and syntax score were insignificant between the two groups (P > 0.05). However, the left ventricular end diastolic volume was significantly larger in CTO (P < 0.05). The patients with stenosis had better MPG than with CTO (P < 0.05). The increased MPG was associated with increased total blush, higher syntax score, and EF (P < 0.05). Successful PCI resulted in better perfusion indicated by increased total blush, and MPG (P < 0.05) but successful PCI did not change syntax score, EF and SDS significantly. Multivariate linear analysis with EF as the dependent factor and syntax score, SDS, total blush, blush area, and MPG as the independent factors showed a significantly higher degree of correlation (R = 0.87, P < 0.05).Conclusion:After PCI the total blush and EF improved significantly indicating its potential application in the future.

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“…However, the earliest time that the recovery of dysfunctional but viable myocardium can be detected remains unknown. Conventional echocardiography enables us to identify significant left ventricular (LV) dysfunction but not subclinical dysfunction [10]. Two-dimensional speckle tracking echocardiography (2D-STE) allows for an angle-independent evaluation of myocardial strain, and provides comprehensive information on LV myocardial contractility.…”

Section: The Role Of Two-dimensional Speckle Tracking Echocardiographymentioning

confidence: 99%

Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusions

Wang

Liu

Ren

2018

Herz

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Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusionsThe role of two-dimensional speckle tracking echocardiography Chronic total occlusion (CTO) is defined as an occluded coronary artery presenting as thrombolysis in myocardial infarction (TIMI) with grade 0 or 1 flow in a recent myocardial infarction (MI) [1,2]. The myocardium in the perfusion territory of a CTO can be functional, dysfunctional but viable, or dysfunctional and nonviable [3,4]. Dysfunctional but viable myocardium in CTO may have restored function after percutaneous coronary intervention (PCI) [5][6][7][8][9]. However, the earliest time that the recovery of dysfunctional but viable myocardium can be detected remains unknown. Conventional echocardiography enables us to identify significant left ventricular (LV) dysfunction but not subclinical dysfunction [10]. Two-dimensional speckle tracking echocardiography (2D-STE) allows for an angle-independent evaluation of myocardial strain, and provides comprehensive information on LV myocardial contractility. Thus, 2D-STE is superior in detecting subtle deteriorations of contractility [11][12][13]. These advantages of 2D-STE are useful for the detection of subclinical recovery of dysfunctional but viable myocardium after CTO-PCI.In this study, the LV systolic function of CTO patients with dysfunctional myocardium was evaluated at 1 day as well as 3 and 6 months after percutaneous revascularization using 2D-STE. It was found that 2D-STE was superior in detecting subclinical LV systolic dysfunction in CTO patients after percutaneous revascularization. Patients and methods SubjectsA single-center prospective observational study was performed from July 2012 to March 2016. Patients with CTO with an estimated duration of less than 3 months or an MI during the previous 30 days were excluded, but no other predefined clinical inclusion or exclusion criteria were applied. The indication for PCI was determined by individual investigators at the participating center. In all, 43 patients (mean age: 66.09 ± 10.99 years) scheduled to undergo PCI for CTO in a native coronary artery were eligible for enrollment. Among them, there were 40 males and three females. The CTO of ten patients was located in the left anterior descending artery in ten patients, in the right coronary artery in 25 patients, and in the circumflex artery in eight patients. A follow-up visit or telephone interview was scheduled at 1 day as well as 3 and 6 months after percutaneous revascularization. Prior written and informed consent was obtained from every patient. This study was approved by the Ethics Review Board of Capital Medical University. Percutaneous revascularizationPercutaneous revascularization was performed by operators highly experienced in the treatment of CTO according to their standard practices with the femoral or brachial approach. The operation was considered successful when the residual stenosis was ≤30% of the intraluminal diameter, with TIMI grade 3 flow and no inhospital complic...

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Myocardial Perfusion Grade After Late Infarct Artery Recanalization Is Associated With Global and Regional Left Ventricular Function at One Year

Cited by 9 publications

References 33 publications

Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure

Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure

Calculation of Coronary Angiographic Total Blush in Patients with Coronary Artery Disease and its Prognostic Implication

Evaluation of left ventricular function after percutaneous recanalization of chronic coronary occlusions

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