Bellandi Francesco, Leoncini Mario, Maioli Mauro, Toso Anna, Gallopin Michela, Piero Dabizzi Roberto
Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy.
Clin Cardiol. 2004 Dec;27(12):683-8. doi: 10.1002/clc.4960271205.
Myocardial blush grade (MBG), corrected TIMI frame count (cTFC), and ST-segment reduction are indices of myocardial reperfusion.
We evaluated their predictive value for left ventricular (LV) function recovery by gated single-photon emission computed tomography (SPECT) after acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).
In 40 patients with AMI, gated SPECT was performed at admission and repeated 7 and 30 days after PCI. Left ventricular function recovery was defined as an increase > or = 10 points in SPECT LV ejection fraction from baseline to 1 month. The MBG, cTFC, and ST-segment elevation index 1 h after PCI were determined to evaluate reperfusion.
Twenty-four patients (Group 1) had LV function recovery and 16 (Group 2) did not. A significant correlation was found between LV function recovery and MBG (r = 0.66; p = 0.0001), and ST-segment elevation index at 1 h (r = -0.55; p = 0.0001), but not with cTFC. Univariate predictors of LV function recovery were MBG (p = 0.0003) and ST-segment elevation index 1 h after intervention (p = 0.0026), but not cTFC. In a multivariate analysis, MBG was the only predictor of LV function recovery. Myocardial blush grade > or = 2 and ST-segment elevation index reduction had the same accuracy (88%) for predicting LV function recovery. Lower accuracy (75%) was shown by fast cTFC (< 23 frames). Myocardial blush grade > or = 2 showed the better negative likelihood ratio, and ST-segment elevation index reduction had the higher positive likelihood ratio in predicting LV function recovery.
Myocardial blush grade was the best parameter for prediction of LV function recovery: MBG > or = 2 and ST-segment elevation index reduction showed good accuracy in predicting LV function recovery. The cTFC failed to be a significant predictor.
心肌灌注分级（MBG）、校正的心肌梗死溶栓分级帧数（cTFC）和ST段压低是心肌再灌注的指标。
我们评估了它们对急性心肌梗死（AMI）接受直接经皮冠状动脉介入治疗（PCI）后通过门控单光子发射计算机断层扫描（SPECT）测量的左心室（LV）功能恢复的预测价值。
40例AMI患者在入院时进行门控SPECT检查，并在PCI术后7天和30天重复检查。左心室功能恢复定义为SPECT左心室射血分数从基线到1个月增加≥10分。测定PCI术后1小时的MBG、cTFC和ST段抬高指数以评估再灌注情况。
24例患者（第1组）左心室功能恢复，16例（第2组）未恢复。左心室功能恢复与MBG（r = 0.66；p = 0.0001）以及1小时时的ST段抬高指数（r = -0.55；p = 0.0001）之间存在显著相关性，但与cTFC无关。左心室功能恢复的单因素预测指标为MBG（p = 0.0003）和干预后1小时的ST段抬高指数（p = 0.0026），而非cTFC。在多因素分析中，MBG是左心室功能恢复的唯一预测指标。心肌灌注分级≥2级和ST段抬高指数降低在预测左心室功能恢复方面具有相同的准确性（88%）。快速cTFC（<23帧）的准确性较低（75%）。心肌灌注分级≥2级在预测左心室功能恢复方面显示出更好的阴性似然比，而ST段抬高指数降低具有更高的阳性似然比。
心肌灌注分级是预测左心室功能恢复的最佳参数：心肌灌注分级≥2级和ST段抬高指数降低在预测左心室功能恢复方面显示出良好的准确性。cTFC未能成为显著的预测指标。
