Assessment of “microvascular no-reflow phenomenon” using technetium-99m macroaggregated albumin scintigraphy in patients with acute myocardial infarction

Kondō, Makoto; Nakano, Akira; Saito, Daiki; Shimono, Yoshiko

doi:10.1016/s0735-1097(98)00435-5

Cited by 121 publications

(74 citation statements)

References 26 publications

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“…Impaired tissue reperfusion after successful recanalization of an epicardial coronary artery has been documented both in animals 6 and in patients [7][8][9][10][11] with AMI. Thus, the degree of functional recovery is related to the extent of microvascular damage.…”

Section: St-segment Resolution and Myocardial Perfusionmentioning

confidence: 99%

“…This socalled "low or no-reflow" phenomenon was first described by Kloner et al in an animal model. 6 Thereafter, this phenomenon has been evaluated by various methods, including myocardial contrast echocardiography (MCE), 7,8 scintigraphy, 9,10 and positron emission tomography (PET) 11 in patients with AMI. However, these techniques are costly and unavailable in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Persistent st‐segment elevation after primary stenting for acute myocardial infarction: Its relation to left ventricular recovery

Lee

Cheong

Shin

et al. 2002

Clinical Cardiology

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SummaryBackground: Early restoration of coronary artery patency in acute myocardial infarction (AMI) has been linked to improvement in survival. However, early recanalization of an occluded epicardial coronary artery by either thrombolytic agents or percutaneous transluminal coronary angioplasty (PTCA) does not necessarily lead to left ventricular (LV) function recovery.Hypothesis: The aim of this study was to evaluate the relation between persistent ST elevation shortly after primary stenting for acute myocardial infarction (AMI) and LV recovery.Methods: Thirty-one patients with primary stenting for AMI were prospectively enrolled. To evaluate the extent of microvascular injury, serial ST-segment analysis on a 12-lead electrocardiogram recording just before and at the end of the coronary intervention was performed. Persistent ST-segment elevation (Persistent Group, n = 11) was defined as ≥ 50% of peak ST elevation and resolution (Resolution Group, n = 20) was defined as < 50% of peak ST elevation. Echocardiography was performed on Day 1 and 3 months after primary stenting.Results: At 3 months, infarct zone wall-motion score index (WMSI, 2.1 ± 0.6 vs. 2.7 ± 0.3, p < 0.05) was smaller in the Resolution Group than in the Persistent Group, whereas wall motion recovery index (RI, 0.4 ± 0.3 vs. 0.1 ± 0.2, p < 0.05)

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Section: St-segment Resolution and Myocardial Perfusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Persistent st‐segment elevation after primary stenting for acute myocardial infarction: Its relation to left ventricular recovery

Lee

Cheong

Shin

et al. 2002

Clinical Cardiology

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“…Some reperfusion parameters can be obtained by myocardial contrast echocardiography, Doppler flow wire, myocardial scintigraphy, and magnetic resonance imaging; however, their application is difficult and time consuming. [1][2][3][4] On the other hand, the resolution of ST-segment elevation, 5,6 the angiographic myocardial blush grade (MBG), 6,7 and the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (cTFC) 8 are early and easily obtainable during the acute stage of AMI treated with primary coronary intervention (PCI) .…”

Section: Introductionmentioning

confidence: 99%

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Bellandi

Leoncini

Maioli

et al. 2004

Clinical Cardiology

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SummaryBackground: Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion.Hypothesis: We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).Methods: In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase ≥ 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST-segment elevation index 1 h after PCI were determined to evaluate reperfusion.Results: Twenty-four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p = 0.0001), and ST-segment elevation index at 1 h (r = Ϫ0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST-segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade ≥ 2 and STsegment elevation index reduction had the same accuracy

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“…TIMI grade 3 epicardial coronary blood flow could be achieved in more than 90% in experienced invasive cardiology centers. However, TIMI grade 3 flow is not equivalent to good myocardial tissue level perfusion thus long-term good clinical outcome and decreased mortality could be obtained, which has been well described in 1990s by different imaging modality studies, such as MRI (19) and radionuclide studies (5). Poor microcirculatory perfusion after primary PCI could result in larger enzymatic infarction size, lower residual LV-EF, higher mortality, and higher incidence of major adverse cardiac events in a long-term follow-up (4).…”

Section: Discussionmentioning

confidence: 99%

Prediction of myocardial tissue loss by quantitative densitometric myocardial blush parameters following ST-elevation myocardial infarction

Sasi¹,

Gavallér²,

Kalapos³

et al. 2015

Acta Physiologica Hungarica

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Tissue level myocardial perfusion is one of the most important prognostic factors after successful recanalisation of the occluded coronary artery in patients suffering acute ST elevation myocardial infarction (STEMI). The primary objective of the present study was to examine the relationship between videodensitometric myocardial perfusion parameters as assessed on coronary angiograms directly following successful recanalization therapy and magnetic resonance imaging (MRI)-derived myocardial tissue loss late after STEMI. The study comprised 29 STEMI patients. Videodensitometric parameter G max /T max was calculated to characterize myocardial perfusion, derived from the plateau of grey-level intensity (G max ), divided by the time-to-peak intensity (T max ). Myocardial loss index (MLI) was assessed by cardiac MRI following 376 ± 254 days after PCI. Results: Significant correlations could be demonstrated between MLI and G max (r = 0.36, p = 0.05) and G max /T max (r = 0.40, p = 0.03) using vessel masking. Using receiver operating characteristic curve analysis, G max /T max < 2.17 predicted best MLI = 0.3, 0.4, 0.5 and 0.6 with good sensitivity and specificity data, while G max /T max < 3.25 proved to have a prognostic role in the prediction of MLI = 0.7. Conclusions: Selective myocardial tissue level perfusion quantitative measurement method is feasible and can serve as a good predictor of myocardial tissue loss following STEMI and revascularization therapy.

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Assessment of “microvascular no-reflow phenomenon” using technetium-99m macroaggregated albumin scintigraphy in patients with acute myocardial infarction

Cited by 121 publications

References 26 publications

Persistent st‐segment elevation after primary stenting for acute myocardial infarction: Its relation to left ventricular recovery

Persistent st‐segment elevation after primary stenting for acute myocardial infarction: Its relation to left ventricular recovery

Markers of myocardial reperfusion as predictors of left ventricular function recovery in acute myocardial infarction treated with primary angioplasty

Prediction of myocardial tissue loss by quantitative densitometric myocardial blush parameters following ST-elevation myocardial infarction

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