Vol 26, No 4 (2019)
Original articles — Interventional cardiology
Published online: 2017-11-03
Quantitative myocardial blush score (QuBE) allows the prediction of heart failure development in long-term follow-up in patients with ST-segment elevation myocardial infarction: Proof of concept study
Abstract
Background: Acute myocardial infarction (AMI) might lead to left ventricular remodeling. Adequate myocardial perfusion is critical to prevent this adverse remodeling. Quantitative myocardial blush evaluator (QuBE) software, available on-line, is a simple analysis tool which enables the precise quantification of myocardial perfusion in the infarct area immediately after interventional treatment. The aim of this study was to assess whether the results of QuBE analysis might predict the development of heart failure (HF) in AMI patients in 3 year-long follow-up.
Methods: Ninety five patients with first AMI, single vessel coronary artery disease, Killip class I at presentation were enrolled in the study. Angiograms were reanalyzed using the on-line QuBE software. Data on heart failure development (ICD 10 codes I50) provided by the National Health Fund were considered as primary outcome.
Results: QuBE values ranged from 0.0 to 25.3 arbitrary units, mean value was 9.9 ± 5.2 arbitrary units. QuBE correlated positively with myocardial blush grade (MBG; Spearman R = 0.342 at p < 0.05). Multivariate Cox proportional hazard modeling, adjusted for initial Thrombolysis in Myocardial Infarction (TIMI flow, and TIMI thrombus grade indicated QuBE score (1 unit increase — HR 0.919, 95% CI 0.846–0.999, p = 0.049) and left ventricular ejection fraction at discharge (1% increase — HR 0.936, 95% CI 0.902–0.971, p = 0.000) as independent predictors of HF development.
Conclusions: The QuBE assessment of myocardial perfusion allows the prediction of HF development in the post-infarction period in this highly selective group of patients.
Keywords: acute myocardial infarctionleft ventricular remodelingprimary percutaneous coronary interventionquantitative myocardial blush evaluator
References
- Araszkiewicz A, Lesiak M, Grajek S. Relationship between tissue reperfusion and postinfarction left ventricular remodelling in patients with anterior wall myocardial infarction treated with primary coronary angioplasty. Kardiol Pol. 2016; 64: 383–388.
- Niccoli G, Scalone G, Lerman A, et al. Coronary microvascular obstruction in acute myocardial infarction. Eur Heart J. 2016; 37(13): 1024–1033.
- Bolognese L, Carrabba N, Parodi G, et al. Impact of microvascular dysfunction on left ventricular remodeling and long-term clinical outcome after primary coronary angioplasty for acute myocardial infarction. Circulation. 2004; 109(9): 1121–1126.
- Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000; 35(3): 569–582.
- Lewis EF, Velazquez EJ, Solomon SD, et al. Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study. Eur Heart J. 2008; 29(6): 748–756.
- van't Hof A, Liem A, Suryapranata H, et al. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction : myocardial blush grade. Circulation. 1998; 97(23): 2302–2306.
- Henriques JPS, Zijlstra F, van 't Hof AWJ, et al. Angiographic assessment of reperfusion in acute myocardial infarction by myocardial blush grade. Circulation. 2003; 107(16): 2115–2119.
- Rasoul S, Dambrink JHE, Breeman A, et al. The relation between myocardial blush grade and myocardial contrast echocardiography: which one is a better predictor of myocardial damage? Neth Heart J. 2010; 18(1): 25–30.
- Tomaszuk-Kazberuk A, Sobkowicz B, Kaminski K, et al. Myocardial perfusion assessed by contrast echocardiography correlates with angiographic perfusion parameters in patients with a first acute myocardial infarction successfully treated with angioplasty. Can J Cardiol. 2008; 24(8): 633–639.
- Bertomeu-González V, Bodí V, Sanchis J, et al. [Limitations of myocardial blush grade in the evaluation of myocardial perfusion in patients with acute myocardial infarction and TIMI grade 3 flow]. Rev Esp Cardiol. 2006; 59(6): 575–581.
- Ungi T, Sasi V, Ungi I, et al. Comparison of two visual angiographic perfusion grades in acute myocardial infarction. Ups J Med Sci. 2009; 114(3): 149–153.
- Fearon WF, Shah M, Ng M, et al. Predictive value of the index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2008; 51(5): 560–565.
- Yamamuro A, Akasaka T, Tamita K, et al. Coronary flow velocity pattern immediately after percutaneous coronary intervention as a predictor of complications and in-hospital survival after acute myocardial infarction. Circulation. 2002; 106(24): 3051–3056.
- Galiuto L, Garramone B, Scarà A, et al. The extent of microvascular damage during myocardial contrast echocardiography is superior to other known indexes of post-infarct reperfusion in predicting left ventricular remodeling: results of the multicenter AMICI study. J Am Coll Cardiol. 2008; 51(5): 552–559.
- Wita K, Filipecki A, Lelek M, et al. Prediction of left ventricular remodeling in patients with STEMI treated with primary PCI: use of quantitative myocardial contrast echocardiography. Coron Artery Dis. 2011; 22(3): 171–178.
- de Waha S, Desch S, Eitel I, et al. Impact of early vs. late microvascular obstruction assessed by magnetic resonance imaging on long-term outcome after ST-elevation myocardial infarction: a comparison with traditional prognostic markers. Eur Heart J. 2010; 31(21): 2660–2668.
- Lombardo A, Niccoli G, Natale L, et al. Impact of microvascular obstruction and infarct size on left ventricular remodeling in reperfused myocardial infarction: a contrast-enhanced cardiac magnetic resonance imaging study. Int J Cardiovasc Imaging. 2012; 28(4): 835–842.
- Vogelzang M, Vlaar PJ, Svilaas T, et al. Computer-assisted myocardial blush quantification after percutaneous coronary angioplasty for acute myocardial infarction: a substudy from the TAPAS trial. Eur Heart J. 2009; 30(5): 594–599.
- Porto I, Hamilton-Craig C, De Maria GL, et al. Quantitative Blush Evaluator accurately quantifies microvascular dysfunction in patients with ST-elevation myocardial infarction: comparison with cardiovascular magnetic resonance. Am Heart J. 2011; 162(2): 372–381.e2.
- Gu YL, Haeck JDE, Vogelzang M, et al. Computer-assisted quantification of myocardial reperfusion after primary percutaneous coronary intervention predicts functional and contrast-enhanced cardiovascular magnetic resonance outcomes in patients with ST-segment elevation myocardial infarction. Catheter Cardiovasc Interv. 2011; 77(2): 174–181.
- Gibson CM, de Lemos JA, Murphy SA, et al. Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation. 2001; 103(21): 2550–2554.
- Sianos G, Papafaklis MI, Daemen J, et al. Angiographic stent thrombosis after routine use of drug-eluting stents in ST-segment elevation myocardial infarction: the importance of thrombus burden. J Am Coll Cardiol. 2007; 50(7): 573–583.
- Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5): 879–888.
- van't Hof AW, Liem A, de Boer MJ, et al. Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction. Zwolle Myocardial infarction Study Group. Lancet. 1997; 350(9078): 615–619.
- Evangelista A, Flachskampf F, Lancellotti P, et al. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008; 9(4): 438–448.
- Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987; 317(17): 1098.
- Jolly SS, Cairns JA, Yusuf S, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med. 2015; 372(15): 1389–1398.
- Vlaar PJ, Svilaas T, van der Horst IC, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008; 371(9628): 1915–1920.
- Gershlick AH, Khan JN, Kelly DJ, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol. 2015; 65(10): 963–972.
- Vlaar PJ, Mahmoud KD, Holmes DR, et al. Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis. J Am Coll Cardiol. 2011; 58(7): 692–703.
- Carrick D, Haig C, Ahmed N, et al. Comparative Prognostic Utility of Indexes of Microvascular Function Alone or in Combination in Patients With an Acute ST-Segment-Elevation Myocardial Infarction. Circulation. 2016; 134(23): 1833–1847.
- Kelly DJ, Gershlick T, Witzenbichler B, et al. Incidence and predictors of heart failure following percutaneous coronary intervention in ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Am Heart J. 2011; 162(4): 663–670.
- Prasad A, Stone GW, Stuckey TD, et al. Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction. J Am Coll Cardiol. 2005; 45(4): 508–514.
- Brener SJ, Maehara A, Dizon JM, et al. Relationship between myocardial reperfusion, infarct size, and mortality: the INFUSE-AMI (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction) trial. JACC Cardiovasc Interv. 2013; 6(7): 718–724.
- Berger JS, Fridman V, Brown DL. Comparison of outcomes in acute myocardial infarction treated with coronary angioplasty alone versus coronary stent implantation. Am J Cardiol. 2006; 97(7): 977–980.
- Härle T, Zeymer U, Schwarz AK, et al. Use of drug-eluting stents in acute myocardial infarction with persistent ST-segment elevation: results of the ALKK PCI-registry. Clin Res Cardiol. 2014; 103(5): 373–380.
- Noman A, Egred M, Bagnall A, et al. Impact of thrombus aspiration during primary percutaneous coronary intervention on mortality in ST-segment elevation myocardial infarction. Eur Heart J. 2012; 33(24): 3054–3061.
- Porto I, Biasucci LM, De Maria GL, et al. Intracoronary microparticles and microvascular obstruction in patients with ST elevation myocardial infarction undergoing primary percutaneous intervention. Eur Heart J. 2012; 33(23): 2928–2938.
