Prediction of myocardial tissue loss by quantitative densitometric myocardial blush parameters following ST-elevation myocardial infarction

Abstract

Tissue level myocardial perfusion is one of the most important prognostic factors after successful recanalisation of the occluded coronary artery in patients suffering acute ST elevation myocardial infarction (STEMI). The primary objective of the present study was to examine the relationship between videodensitometric myocardial perfusion parameters as assessed on coronary angiograms directly following successful recanalization therapy and magnetic resonance imaging (MRI)-derived myocardial tissue loss late after STEMI. The study comprised 29 STEMI patients. Videodensitometric parameter Gmax/Tmax was calculated to characterize myocardial perfusion, derived from the plateau of grey-level intensity (Gmax), divided by the time-to-peak intensity (Tmax). Myocardial loss index (MLI) was assessed by cardiac MRI following 376 ± 254 days after PCI. Results: Significant correlations could be demonstrated between MLI and Gmax (r = 0.36, p = 0.05) and Gmax/Tmax (r = 0.40, p = 0.03) using vessel masking. Using receiver operating characteristic curve analysis, Gmax/Tmax < 2.17 predicted best MLI = 0.3, 0.4, 0.5 and 0.6 with good sensitivity and specificity data, while Gmax/Tmax < 3.25 proved to have a prognostic role in the prediction of MLI = 0.7. Conclusions: Selective myocardial tissue level perfusion quantitative measurement method is feasible and can serve as a good predictor of myocardial tissue loss following STEMI and revascularization therapy.