Use of the TIMI frame count in the assessment of coronary artery blood flow and microvascular function over the past 15 years

Kunadian, Vijayalakshmi; Harrigan, Caitlin; Zorkun, Cafer; Palmer, Alexandra M.; Ogando, Katherine J.; Biller, Leah H.; Lord, Erin; Williams, Scott; Lew, Michelle; Ciaglo, Lauren N.; Buros, Jacqueline L.; Marble, Susan J.; Gibson, William J.; Gibson, C. Michael

doi:10.1007/s11239-008-0220-3

Cited by 52 publications

(46 citation statements)

References 90 publications

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“…This means that the TIMI frame count analysis may be insufficient for reflecting the amount of viable myocardium. 13 The present study suggests that caution is needed when assessing the functional severity of coronary stenosis in prior-MI-related coronary arteries by cQFR or fQFR.…”

Section: Discussionmentioning

confidence: 82%

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

Emori

Kubo

Kameyama

et al. 2018

Circ J

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related coronary arteries. Angiographically severe stenoses in prior-MI-related coronary arteries are not necessary to induce myocardial ischemia because the amount of viable myocardium is reduced. 9-11 Previous studies have demonstrated that FFR can accurately assess the degree of ischemia even in prior-MI-related coronary arteries, 11,12 but QFR may not consider the amount of viable myocardium because this index is estimated from the anatomic information of the epicardial coronary artery. Therefore, we investigated the diagnostic accuracy of QFR in prior-MI-related coronary arteries as compared with FFR. Methods Study PopulationThe present study was a retrospective, single-center study of patients who underwent CAG and FFR. We analyzed a consecutive series of 75 prior-MI-related coronary arteries (examined in 75 patients between July 2012 and December 2016) and a consecutive series of 75 non-prior-MI-related F ractional flow reserve (FFR) is a useful index of the functional significance of a coronary stenosis. 1 It is obtained during routine coronary angiography (CAG) by using a pressure wire. 2 FFR is independent of heart rate, systemic blood pressure and cardiac output and takes into account myocardial territory and viability and collateral perfusion. 2-5 However, FFR has some disadvantages, such as risks of pressure wire injury, side effects of hyperemic agents and additional costs.Quantitative flow ratio (QFR) is a novel approach to assessing the functional severity of a coronary stenosis. It is calculated from 3D quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis.

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Section: Discussionmentioning

confidence: 82%

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

Emori

Kubo

Kameyama

et al. 2018

Circ J

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“…Therefore, after successful revascularization of an epicardial coronary stenosis, contrast medium progression impairment could reflect microcirculation damage. From the Thrombolysis in Myocardial Infarction (TIMI) study group, two indices were described: TIMI flow grade 0-3 is a semi-quantitative variable that ranges from no contrast medium progression (0) to normal progression (3); TIMI frame count is a quantitative index calculating the number of frames between two landmarks proximal and distal to the interrogated coronary artery [9]. In patients with ACS and preserved TIMI grade flow after revascularization, microcirculation can also be evaluated with myocardial blush, which corresponds to a densitometric method, assessing maximum intensity of contrast medium in the microcirculation.…”

Section: Coronary Angiographymentioning

confidence: 99%

A Handbook of Primary PCI: No-Reflow Management

Adjedj

Müller

Eeckhout

2018

Primary Angioplasty

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Although substantial progress has been made in recent decades in reducing mortality and performing optimal revascularization in patients with acute coronary syndrome (ACS) and stable coronary artery disease (CAD), one of the remaining challenges is to better prevent and treat extended myocardial damage despite "apparent" angiographic optimal percutaneous coronary intervention (PCI). The presence of no-reflow is related to higher risk of major adverse cardiac events (MACE) due to the poor healing of the infarct, adverse left ventricular remodelling, congestive heart failure occurrence and death. Despite optimal epicardial coronary artery reperfusion performed by PCI, distal microembolization into the coronary microcirculation limits myocardial salvage especially during ACS. No-reflow represents the ultimate stage of extended myocardial damage after PCI with absence of contrast medium progression in the coronary artery. This complication occurs mainly during ACS or during PCI of rotational atherectomy and venous graft in stable patients. The objective of this chapter is to describe how to manage a noreflow phenomenon from the pathophysiology to the management in order to help physician to prevent this complication and if no-reflow occurs adapt therapeutics to limit myocardial damage and reduce poor outcomes. DefinitionThe no-reflow phenomenon is defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical obstruction [1].

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“…Despite achievement of TIMI 3 flow in 96.1% of patients in the trial, only 17.4% of patients had normal myocardial perfusion as assessed by blush grade (34). Corrected TIMI frame count has also been correlated with microvascular reperfusion and myocardial salvage (30,35,36). Because of the CAPITAL AMI study design, CTFC was not possible in patients randomly assigned to the TNK-alone arm.…”

Section: Figure 2) Mean Percentage St Segment Resolution (Str) At 180mentioning

confidence: 99%

ST segment resolution in patients with tenecteplase-facilitated percutaneous coronary intervention versus tenecteplase alone: Insights from the Combined Angioplasty and Pharmacological Intervention versus Thrombolysis ALone in Acute Myocardial Infarction (CAPITAL AMI) trial

Davies

et al. 2010

Canadian Journal of Cardiology

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METHODS AND RESULTS:A formal ST segment analysis was conducted on the 170 patients with ST elevation myocardial infarction in the CAPITAL AMI trial: 86 patients treated with TNK-facilitated PCI were compared with 84 patients who were treated with TNK alone. Epicardial flow measured by percentage with Thrombolysis In Myocardial Infarction (TIMI) 3 flow improved from 52% (pre-PCI) to 89% (post-PCI) in those assigned to facilitated PCI. ST segment resolution was stratified by complete (70% or greater), partial (less than 70% to 30%) or no (less than 30% to 0%) resolution. The baseline mean ST segment elevation was 11.3±7.5 mm in the facilitated PCI patients and 11.8±7.1 mm in patients with TNK alone (P=0.66). Complete STR in the facilitated PCI patients versus the TNK-alone patients was present in 55.6% versus 54.6%, respectively (P=0.58) at 180 min and 62.0% versus 55.3% (P=0.64), respectively at day 1. The mean STR at 180 min and day 1 were similar in patients who experienced death, reinfarction, recurrent unstable ischemia or stroke at six months compared with patients who remained event free: 56.3% versus 64.6% at 180 min (P=0.40); and 67.7% versus 67.6% at day 1 (P=0.99), respectively. CONCLUSIONS: TNK-facilitated PCI did not demonstrate differences in ST segment resolution compared with TNK alone, despite improvement in epicardial flow after PCI. Further studies are required to clarify these findings.

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Use of the TIMI frame count in the assessment of coronary artery blood flow and microvascular function over the past 15 years

Abstract: Since its introduction, the TIMI frame count method has contributed to the understanding of the pathophysiology of coronary artery disease. In this article, the evolution of the TFC method and its applicability in the assessment of various therapeutic modalities are described.

Cited by 52 publications

References 90 publications

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

A Handbook of Primary PCI: No-Reflow Management

ST segment resolution in patients with tenecteplase-facilitated percutaneous coronary intervention versus tenecteplase alone: Insights from the Combined Angioplasty and Pharmacological Intervention versus Thrombolysis ALone in Acute Myocardial Infarction (CAPITAL AMI) trial

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