Quantitative myocardial blush grade: Prepped for a core lab standardization
✍ Scribed by Christoph Hehrlein
- Book ID
- 101826312
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 39 KB
- Volume
- 76
- Category
- Article
- ISSN
- 1522-1946
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✦ Synopsis
In this issue of Catheterization and Cardiovascular Interventions, Riedle et al. [1] report on the comparison of a novel method quantifying myocardial blush grades (qMBG) in ST-segment elevation myocardial infarction (STEMI) and non ST-segment myocardial infarction (NSTEMI) patients with the gold standard of magnetic resonance imaging (MRI). The authors found a high predictive value of qMBG in estimating the infarct size at follow-up obtained by MRI. Previous articles on MBG already showed its potential value by the strong correlation with thrombolysis in myocardial infarction (TIMI) flow frame counts and ST-segment resolution [2,3]. However, TIMI frame counts are not sensitive enough to detect microvascular perfusion deficits because the time is measured the contrast takes to travel through the epicardial artery reaching the myocardial phase but the microcirculation is not part of the evaluation. Thus, physiologically relevant and decision-making information is lacking when TIMI frame counts alone are used to predict infarct sizes. Quantification of microcirculatory perfusion has been standardized for the use of ultrasound contrast agents [4,5]. The intriguing aspect of qMPG is its convenient, immediate application after myocardial reperfusion therapy derived directly from the angiograms after the intervention. In the TAPAS trial, analyzing the effects of thrombus extraction catheter in AMI patients, the ''classic'' MPG score was used to document superiority of treatment over standard percutaneous intervention along with standard semiquantitative analysis of ST-segment resolution [3]. The classic MPG score is not a reproducible tool because of its high intraobserver and interobserver variability. Vogelzang et al.
[6] nicely showed that a computer-assisted myocardial blush grade quantification overcomes this disadvantage. These authors found a very high intraobserver and interobserver agreement between for computerized MPG quantification (QuBE) in the determination of