Correlation of QRS duration with myocardial blush grade as a marker of myocardial reperfusion in primary percutaneous coronary intervention

Yusuf, Jamal; Das, Dipankar; Mukhopadhyay, Saibal; Tyagi, Sanjay

doi:10.1016/j.ihj.2018.10.412

Cited by 11 publications

(16 citation statements)

References 25 publications

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“…9 Three studies (Yusuf et al, Ilkay et al, and Kacmaz et al) mentioned a third investigator who resolves the discordance between the two investigators. 8,11,12 Karahan et al did not mention a third investigator but reported an intra-and interobserver agreement of 95% and 90%, respectively, which is similar to that in Yusuf et al's study, which employed the third investigator to resolve the dispute. 2,11 Ozcan et al hypothesized that fQRS correlated with the extent of myocardial damage due to a lowered left ventricular ejection fraction in their study and that better microvascular perfusion leads to the resolution of fQRS.…”

Section: Subgroup Analysissupporting

confidence: 53%

“…8,11,12 Karahan et al did not mention a third investigator but reported an intra-and interobserver agreement of 95% and 90%, respectively, which is similar to that in Yusuf et al's study, which employed the third investigator to resolve the dispute. 2,11 Ozcan et al hypothesized that fQRS correlated with the extent of myocardial damage due to a lowered left ventricular ejection fraction in their study and that better microvascular perfusion leads to the resolution of fQRS. 13 This may indicate that fQRS might be because of poor microvascular perfusion that resulted in alteration of electrical activities, resulting in a different pattern of depolarization.…”

Section: Subgroup Analysissupporting

confidence: 53%

“…1). 2,[8][9][10][11][12] These studies are a prospective observational study. There were a total of 1,311 patients from six studies; five studies used primary PCI for the reperfusion attempt, and one study used fibrinolytic.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies (Cetin et that QRS duration was measured for three consecutive beats. 2,8,11 Discriminating end of QRS duration and beginning of ST-segment is sometimes tricky in the presence of several conditions. MBG is also a qualitative measurement and subject to bias, all but one study (Cetin et al) 9 specified that two investigators were reading the angiography for MBG.…”

Section: Subgroup Analysismentioning

confidence: 99%

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Fragmented QRS and QRS Duration As a Marker of Myocardial Reperfusion Measured by Myocardial Blush Grade in Reperfusion Therapy: Systematic Review and Meta-Analysis

et al. 2019

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Myocardial blush grade (MBG) is an indicator of microvascular perfusion and patency and an independent predictor of cardiac outcomes. QRS duration and fragmented QRS (fQRS) before reperfusion and its changes after reperfusion are shown to be associated with MBG. We aimed to assess the latest evidence on the association between fQRS and QRS duration with MBG in reperfusion therapy.We performed a comprehensive search on the association between fQRS and QRS duration in successful/impaired reperfusion measured by MBG.There were a total of 1,311 patients from six studies. A shorter QRS duration immediately and at 60 minutes after reperfusion attempt was associated with successful reperfusion, with a mean difference (MD) of –10.62 ms ([–15.55, –5.70]; p < 0.001; I 2 = 69%) and –15.66 ms ([–19.96, –11.37]; p < 0.001; I 2 = 77%), respectively, and upon sensitivity analysis, with exclusion of a study, heterogeneity decreases to 33 and 0%. QRS narrowing immediately and 60 minutes after reperfusion attempt was correlated with reperfusion, with an MD of –10.72 ([–16.57, –4.88] ; p < 0.001; I 2 = 97%) and –10.93 ([–14.00, –7.85]; p < 0.001; I 2 = 97%), lesser in impaired reperfusion, respectively. QRS duration on admission was not associated with reperfusion outcome. Two studies reported that fQRS was associated with impaired perfusion, with an odds ratio of 9.88 ([5.62–17.38]; p < 0.0001) and 4.74 ([2.45–9.20]; p < 0.0001), respectively.A longer QRS duration immediately and at 60 minutes after reperfusion attempt was associated with impaired perfusion. QRS narrowing after reperfusion attempt was correlated with successful reperfusion. fQRS was also associated with a higher probability of impaired perfusion.

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Section: Subgroup Analysissupporting

confidence: 53%

Section: Subgroup Analysissupporting

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Section: Subgroup Analysismentioning

confidence: 99%

See 2 more Smart Citations

Fragmented QRS and QRS Duration As a Marker of Myocardial Reperfusion Measured by Myocardial Blush Grade in Reperfusion Therapy: Systematic Review and Meta-Analysis

et al. 2019

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“…The real-time myocardial perfusion imaging with Myocardial Blush determination Grade (MBG) was used to measure myocardial perfusion [23]. The MBG was scored during angiographic analysis according to the conventional method [24].…”

Section: Real-time Myocardial Perfusion Imaging Determinationmentioning

confidence: 99%

Macrophage Migration Inhibitory Factor Levels Predict No-reflow in ST-segment Elevation Myocardial Infarction.

Storozhenko¹,

Vishnevskaya²,

Kopytsya³

et al. 2021

Pharmacophore

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To elucidate whether Macrophage Migration Inhibitory Factor (MIF) levels anticipate no-reflow among ST-segment Elevation Myocardial Infarction (STEMI) patients. We enrolled 120 STEMI individuals given treatment with initial PCI. Assessment of the ST-segment dynamics was performed with serial 12-lead ECGs obtained before and after primary PCI within 1-2 hours at 50 mm/sec. In the case of impaired microcirculatory perfusion, the dynamics of ST-segment elevation resolution (STR) remain equal to 70% or less. The real-time myocardial perfusion imaging with myocardial blush grade determination was used to identify no-reflow. ELISA measured the levels of MIF before and after PCI. We found that higher plasma MIF contents were indicated in the entire STEMI patients' population when compared to the healthy volunteers' group (3400 [2089.0-5571.0] pg/mL and 721 [567.3-1104.1] pg/mL respectively, р<0.001), and the pre-PCI MIF contents did not substantially distinguish from post-PCI MIF levels. Patients with no-reflow had significantly higher pre-PCI and post-PCI MIF levels than those who did not have it. ROC characteristics showed that well-balanced cut-off of pre-PCI MIF levels that predicted the no-reflow condition was 3663 pg/mL (sensitivity =74%, specificity =72%, 95% CI=0.585-0.857; p = 0.0023). Pre-PCI MIF levels > 3663 pg/mL predicted the no-reflow, whereas post-PCI MIF levels did not demonstrate a discriminative potency for it. The pre-PCI MIF levels > 3663 pg/mL and female gender were independent predictors for the no-reflow phenomenon. In STEMI patients, elevated pre-PCI MIF levels (>3663 pg/mL and >5033 pg/mL, respectively) predicted post-procedural noreflow phenomenon and systolic cardiac dysfunction.

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Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study

et al. 2021

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Correlation of QRS duration with myocardial blush grade as a marker of myocardial reperfusion in primary percutaneous coronary intervention

Cited by 11 publications

References 25 publications

Fragmented QRS and QRS Duration As a Marker of Myocardial Reperfusion Measured by Myocardial Blush Grade in Reperfusion Therapy: Systematic Review and Meta-Analysis

Fragmented QRS and QRS Duration As a Marker of Myocardial Reperfusion Measured by Myocardial Blush Grade in Reperfusion Therapy: Systematic Review and Meta-Analysis

Macrophage Migration Inhibitory Factor Levels Predict No-reflow in ST-segment Elevation Myocardial Infarction.

Intravenous metoprolol during ongoing STEMI ameliorates markers of ischemic injury: a METOCARD-CNIC trial electrocardiographic study

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