TIMI myocardial perfusion frame count: A new method to assess myocardial perfusion and its predictive value for short‐term prognosis

Ding, Song; Pu, Jun; Qiao, Zhiqing; Shan, Peiren; Song, Wei; Du, Yiqin; Shen, Jieyan; Jin, S.; Sun, Yu; Shen, Long; Lim, Yu Liang; He, Ben

doi:10.1002/ccd.22298

Cited by 42 publications

(33 citation statements)

References 27 publications

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“…In the present study, six patients showed persistence of myocardial blush in the distribution of the culprit artery, suggesting leakage of contrast medium into the pPCI, primary percutaneous coronary intervention extravascular space secondary to destruction of the microcirculation network structure-the most severe form of microvascular dysfunction [6,7]. As described previously and following a similar principle to that used in the definition of corrected TIMI frame count (CTFC) [15], a frame count of 306, corresponding to the 99th percentile of TMPFC encountered in the present study, was assigned to these patients [5].…”

Section: Coronary Angiographymentioning

confidence: 99%

“…Epicardial coronary flow was assessed by TIMI flow grade: grade 0, absent antegrade flow; grade 1, partial contrast penetration, incomplete distal filling; grade 2, patent with opacification of the entire distal artery, delayed contrast filling or washout; and grade 3, patent with normal flow [14]. Myocardial microvascular perfusion was assessed by TMPFC [5]. TMPFC is a simple quantitative index for assessing myocardial microvascular perfusion which was derived by modifying TMPG by the method of frame counting.…”

Section: Coronary Angiographymentioning

confidence: 99%

“…Microvascular dysfunction (MVD) is a common complication after reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI), which has been confirmed to be associated with increased post-procedural myocardial infarction occurrence, in-hospital mortality, adverse left ventricular (LV) remodeling and diminished recovery of LV function [1][2][3][4][5]. Traditional angiographic methods for assessment of myocardial tissuelevel perfusion were thrombolysis in myocardial infarction (TIMI) myocardial perfusion grading (TMPG) and myocardial blush grading (MBG), which were limited by their subjective and categorical nature [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Traditional angiographic methods for assessment of myocardial tissuelevel perfusion were thrombolysis in myocardial infarction (TIMI) myocardial perfusion grading (TMPG) and myocardial blush grading (MBG), which were limited by their subjective and categorical nature [6,7]. In a previous study, we developed a novel and objective method named TIMI Myocardial Perfusion Frame Count (TMPFC), which measured the filling and clearance of contrast in the myocardium using cine-angiographic frame-counting to quantify myocardial tissue-level perfusion [5]. As a quantitative index for the assessment of myocardial perfusion, TMPFC proved to be a useful predictor of clinical prognosis [5,8,9].…”

Section: Introductionmentioning

confidence: 99%

“…In a previous study, we developed a novel and objective method named TIMI Myocardial Perfusion Frame Count (TMPFC), which measured the filling and clearance of contrast in the myocardium using cine-angiographic frame-counting to quantify myocardial tissue-level perfusion [5]. As a quantitative index for the assessment of myocardial perfusion, TMPFC proved to be a useful predictor of clinical prognosis [5,8,9]. Recent studies have revealed that myocardial deformation assessed using speckle-tracking echocardiography (STE) predicts LV remodeling and has additional prognostic value in acute myocardial infarction relative to traditional two dimensional (2D) echocardiography [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion

Ding

Qiao

et al. 2016

Int J Cardiovasc Imaging

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To investigate the impact of microvascular dysfunction assessed by angiography on myocardial deformation assessed by two-dimensional speckle-tracking echocardiography in ST-segment elevation myocardial infarction (STEMI). A total of 121 STEMI patients who received primary percutaneous coronary intervention were included. Thrombolysis in myocardial infarction, Myocardial Perfusion Frame Count (TMPFC), a novel angiographic method to assess myocardial perfusion, was used to evaluate microvascular dysfunction. Two-dimensional speckle-tracking echocardiography was performed at 3-7 days after reperfusion. The infarction related regional longitudinal (RLS) strains as well as circumferential (RCS) and radial (RRS) ones, along with global longitudinal, circumferential (GCS), and radial (GRS) strains were measured. Patients with microvascular dysfunction had decreased peak amplitude of RLS (p = 0.012), RCS (p < 0.001), RRS (p = 0.012) at the regional level and decreased peak amplitude of GCS (p = 0.005), GRS (p = 0.012) at the global level. The RCS to RLS and RCS to RRS ratios were significantly different between patients without than with microvascular dysfunction (1.28 ± 0.31 vs. 1.07 ± 0.47, p = 0.027 and 0.69 ± 0.33 vs. 0.56 ± 0.28, p = 0.047). Receiver operator characteristics curves identified a cutoff value of 94 frames for TMPFC to differentiate between normal and abnormal wall motion score index in the sub-acute phase of STEMI (AUC = 0.72; p < 0.001). In the sub-acute phase of STEMI, the presence of microvascular dysfunction in infarcted tissue relates to reduced global and regional myocardial deformation. RCS alterations were more significant than RLS and RRS between patients with than without microvascular dysfunction. TMPFC was useful to predict left ventricular systolic dysfunction in the sub-acute phase of STEMI.

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Section: Coronary Angiographymentioning

confidence: 99%

Section: Coronary Angiographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion

Ding

Qiao

et al. 2016

Int J Cardiovasc Imaging

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Improving the quantitation of myocardial perfusion using a new method: The TMPFC

Kern

2010

Cathet Cardio Intervent

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Ding et al. [1] proposed a new method to better quantify myocardial perfusion called TIMI myocardial perfusion frame count (TMPFC). By counting frames of contrast passing through the perfusion bed beyond the stenotic infarct related artery, a quantitative advance over the longstanding qualitative TIMI myocardial perfusion grading (TMPG) and myocardial blush grading (MBG) assessments can be made. The TMPFC differed from the corrected TIMI frame count (cTFC) in that the first frame of the TMPFC was defined as that frame where the first appearance of myocardial blush beyond the infarct related artery was seen. The last was that frame in which the contrast blush disappeared.TMPFC was calculated in 45 normal coronary arteries in 15 patients and 137 culprit arteries in 137 primary angioplasty patients. For normal arteries, mean TMPFC was 83.5 1/2 18, ranging from 78 to 89, and TMPFC number <90 was the delimiter of normal myocardial perfusion. In the culprit artery undergoing primary PCI, the RCA, LAD, and circumflex had TMPFCs of 141, 112, and 102 frames, respectively. Suboptimal perfusion had higher TMPFCs. More importantly and clinically relevant is that the multivariant analysis showed that the TMPFC was independent predictor of 30-day and 6-month MACE, (both P < 0.02). TMPFC is a more quantitative index for the assessment of myocardial perfusion and similar to the TMPG in that the status of the microcirculation predicts prognosis after primary PCI.This relatively simple concept has been too long time in arriving to our world of digital angiography with techniques and nomenclature persisting as the extinction of cine film and frame rates years ago. Ding et al. should be congratulated in moving the assessment of acute infarct reperfusion forward from Gibson et al's [2] standard cine based approach. The fact that a digital frame count can be easily performed on any of the imaging computers makes this advance widely available in any laboratory. However, the novel methodology deserves a brief cautionary note. The operators still must apply some degree of subjectivity in selecting the first and last frames of contrast arrival and departure from the infarct vessel territory. Care should be taken to minimize superimposition of noninfarct regions. The correct assessment of myocardial blush washout needed to terminate the frame count might also be variable, despite the reporting of good intra-and inter-observer variability in the investigators' laboratory. Venous filling should not be mistaken for myocardial perfusion blush.The absence of myocardial blush certainly limits one's ability to use the TMPFC. This problem occurred in 10 study patients in whom no myocardial blush or persistence of myocardial blush in the distribution of the culprit artery was observed. The reproducibility of the technique appeared to be very satisfactory. It is interesting to note that the comparison with TMP grade 2 had very wide ranging TMPFC counts from 30 up to 209. For TIMI 3 grades, the TMPFC spectrum was shifted with the mode around 60 to 89...

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TIMI myocardial perfusion frame count: Turning blush into numbers

Prado

Cuellas

Diego

et al. 2011

Cathet Cardio Intervent

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TIMI myocardial perfusion frame count: A new method to assess myocardial perfusion and its predictive value for short‐term prognosis

Abstract: TMPFC is a quantitative index for the assessment of myocardial perfusion; it allows quantification of TMPG and may serve as a discerning tool to predict prognosis in patients undergoing primary angioplasty.

Cited by 42 publications

References 27 publications

Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion

Influence of microvascular dysfunction on regional myocardial deformation post-acute myocardial infarction: insights from a novel angiographic index for assessing myocardial tissue-level reperfusion

Improving the quantitation of myocardial perfusion using a new method: The TMPFC

TIMI myocardial perfusion frame count: Turning blush into numbers

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