The clinical implications of no reflow demonstrated with intravenous perfluorocarbon containing microbubbles following restoration of Thrombolysis in Myocardial Infarction (TIMI) 3 flow in patients with acute myocardial infarction

Porter, Thomas R.; Li, Shouping; Oster, Rebecca; Deligönül, Ubeydullah

doi:10.1016/s0002-9149(98)00597-9

Cited by 109 publications

(49 citation statements)

References 12 publications

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“…TMPG-3 on coronary angiogram is generally achieved only in less than 30% of the patients with AMI after primary PCI (Gibson et al,2000) (Costantini et al,2004), while good reflow is observed on 2D-MCE in about 70% of the patients (Ito et al,1992) (Galiuto et al,1998) (Porter et al,1998). TMPG grade was far better correlated with MOE on 3D-MCE than with perfusion pattern on 2D-MCE in the present study.…”

Section: Comparison Between 2d-and 3d-mce For Detection Of the No-reflowsupporting

confidence: 43%

“…They performed MCE using intracoronary injection of fragile microbubbles through catheter. The no-reflow phenomenon was also observed by MCE with intravenous administration of stable microbubbles, which is capable of passing through pulmonary circulation and into coronary microcirculation (Porter et al,1998). These studies indicated that no-reflow phenomenon is observed in 25-40% of patients receiving successful primary PCI resulting into TIMI-3 flow grade.…”

Section: Myocardial Contrast Echocardiography (Mce)mentioning

confidence: 68%

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3D Myocardial Contrast Echocardiography

Iwakura¹

2012

Echocardiography - New Techniques

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Section: Comparison Between 2d-and 3d-mce For Detection Of the No-reflowsupporting

confidence: 43%

Section: Myocardial Contrast Echocardiography (Mce)mentioning

confidence: 68%

3D Myocardial Contrast Echocardiography

Iwakura¹

2012

Echocardiography - New Techniques

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“…No-refl ow phenomenon is found in 25% to 30% patients with AMI, despite successful coronary reperfusion and is associated with a worse outcome (17,18). Studies have demonstrated that acute hyperglycemia is associated with reduced spontaneous coronary perfusion and impaired tissue perfusion as compared to euglycemia (19,20).…”

Section: Discussionmentioning

confidence: 99%

Relationship between TIMI frame count and admission glucose values in acute ST elevation myocardial infarction patients who underwent successful primary percutaneous intervention

Ege

Güray²,

Güray³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Akut miyokart enfarktüsü ile başvuran hastalarda hiperglisemi olumsuz prognozla ilişkilidir. Primer perkütan koroner girişim (PKG) yapılan hastalarda, enfarkttan sorumlu arterin işlem sonu Miyokart Enfarktüste Trombolizis (TIMI) kare sayıları başarılı reperfüzyona rağmen önemli oranda farklılık gösterebilmektedir. Bu prospektif gözlemsel çalışmada ST yükselmeli miyokart enfarktüsü (STYMİ) sebebi ile başarılı primer PKG uygulanan hastalarda başvuru glikoz değerleri ile işlem sonucunda sorumlu koroner arter TIMI kare sayılarının ilişkisi araştırılmıştır. Yöntemler: Altı aylık zaman süresi içerisinde, STYMİ ile başvuran ve PKG ile TIMI 3 akım sağlanan ardışık 73 diyabetes mellitusu olmayan hasta çalışmaya dahil edilmiştir. Hastalar TIMI kare sayılarına göre iki gruba bölünmüştür. Grup 1 (n=53), enfarkttan sorumlu koroner arter TIMI kare ABSTRACT Objective: Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction. Final Thrombolysis in Myocardial Infarction (TIMI) frame counts of culprit coronary arteries may show significant variability despite successful coronary reperfusion after primary percutaneous coronary intervention (PCI). In this prospective observational study, relationship between final TIMI frame counts of the culprit coronary artery and admission glucose values was investigated in patients who underwent successful primary PCI due to acute ST-elevation myocardial infarction (STEMI). Methods: During a 6-month period of time, 73 non-diabetic patients presented with acute STEMI who have undergone primary PCI with final TIMI 3 flow were consecutively included in the study. Patients were divided into two groups according to final TIMI frame counts. Group 1 (n=53) consisted of patients with final TIMI frame counts of the culprit coronary artery within the two standard deviation of predefined values and Group 2 (n=20) consisted of those with higher TIMI frame counts. Statistical analysis was performed using Chi-square, Mann-Whitney U tests and multiple linear regression analysis. Results: Despite similar fasting glucose values, admission glucose levels were significantly higher in Group 2 as compared to vs. 123 mg/dl, p=0.03). In whole group, admission glucose values were significantly correlated with corrected TIMI frame counts of culprit coronary arteries (r=0.30, p=0.01). In addition, there were significant association between admission glucose values and peak creatine kinase-MB (r=0.36, p=0.007) values as well as left ventricular ejection fraction (r=-0.43, p=0.009). In multiple linear regression analysis, only admission glucose value was found to be significantly related to the final TIMI frame count of the culprit artery (β=0.04, 95% CI: 0.02-0.085, p=0.04). Conclusion: High admission glucose values were significantly associated with impaired coronary flow even after successful primary PCI in non-diabetic patients with STEMI. (Anadolu Kardiyol Derg 2011; 11: 213-7)

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“…17) Although myocardial contrast echocardiography, which can demonstrate tissue perfusion, may be beneficial in detecting the frequency of no-reflow, [8][9][10] its unpractical application limits its efficacy. However, TIMI flow grade is accepted as a simple alternative with which to detect no-reflow without an additional method or extra time.…”

Section: Discussionmentioning

confidence: 99%

Treatment of No-Reflow Phenomenon with Verapamil after Primary Stent Deployment during Myocardial Infarction.

et al. 2002

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SUMMARYNo-reflow phenomenon is the absence of myocardial perfusion despite adequate dilatation of the infarct related coronary artery during percutaneous coronary intervention. It predicts severe left ventricular dysfunction and poor prognosis in acute myocardial infarction (AMI). The present case is a 54 year old Turkish female who presented with chest pain that had started 2.5 hours earlier. The clinical and laboratory findings were consistent with AMI and the coronary angiogram performed for primary angioplasty revealed a 95% thrombotic occlusion with a TIMI grade I flow in the left anterior descending (LAD) coronary artery. A TIMI grade III flow was achieved with direct stent deployment. However, after the placement of a second stent for severe ostial stenosis more proximally and adjacent to the first one, the antegrade flow became TIMI grade O. As the intracoronary medications did not improve the flow, a mechanical occlusion was considered and a third stent was deployed covering the first two stents. A control angiogram revealed the persistence of TIMI grade O flow. A severe and persistent vasospasm was considered at this point and accordingly, intracoronary verapamil was administered in high concentrations by an infusion catheter to the distal LAD which was followed by the immediate achievement of TIMI grade III flow. Intracoronary administration of high dose verapamil can be performed to prevent vasospasm in resistant no-reflow cases with no evidence of mechanic occlusion. ( and is known to prevent ischaemic myocardial dysfunction.2) However, some studies have showed the absence of expected functional recovery in the left ventricle, despite normal flow in the epicardial coronary artery.3) The 'no-reflow' phenomenon is the absence of myocardial perfusion, despite adequate dilatation of the responsible artery, without a dissection, mechanic obstruction, or distal emboli. 4,5) The 'no-reflow' phenomenon can be detected by angiography, 3) scinFrom

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The clinical implications of no reflow demonstrated with intravenous perfluorocarbon containing microbubbles following restoration of Thrombolysis in Myocardial Infarction (TIMI) 3 flow in patients with acute myocardial infarction

Cited by 109 publications

References 12 publications

3D Myocardial Contrast Echocardiography

3D Myocardial Contrast Echocardiography

Relationship between TIMI frame count and admission glucose values in acute ST elevation myocardial infarction patients who underwent successful primary percutaneous intervention

Treatment of No-Reflow Phenomenon with Verapamil after Primary Stent Deployment during Myocardial Infarction.

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