Purpose
The no reflow phenomenon (NR) is the inability of blood to reperfuse an ischemic area despite a successful revascularization,
mostly due to microvascular obstruction (MVO) [1].
Coronary angiography is the most used technique in NR evaluation: it is fast and can be assessed at the end of the PCI procedure.
The presence of MVO is established based on angiographic scores.
The two mainly used scores are the TIMI flow grade and Myocardial Blush Grade (MBG): NR is present when TIMI is <3 and/or MBG is...
Methods and Materials
We enrolled 23 consecutive patients with ST-elevation Myocardial Infarction (STEMI) within 12 hours of symptom onset,
who underwent PCI.
In PCI studies NR was defined as TIMI grade<3 and/or blush grade<2 post-PCI.
The exclusion criteria for CMR were: history of ischemic cardiomyopathy with left ventricular ejection fraction (LVEF) <35% before the infarction; age <18 o >80 yrs; BMI >35; ICD or pacemaker holders; contraindication to MR and contrast medium.
The CMR was performed on a 1.5 T magnet with the assessment of Cine sequences (BFFE-...
Results
All patients showed myocardial oedema (33±9%) and LE (28±11%) at CMR.
The average EF was slightly depressed (50.19 ± 9.89) (see fig.
5 and 6)
17 patients showed NR considering both CMR and coronary angiography.
In particular we observed that 16 patients showed MVO at CMR,
while only 9 patients showed MVO at coronary angiography.
Among the group of 9 patients positive for MVO at angiography one was negative at CMR.Considering MVO at CMR,
it was present on all dedicated sequences: FFP (3± 3%),
EE...
Conclusion
Our preliminary data confirm that CMR is a more powerful tool than angiography in MVO identification and suggest that among angiography parameters TIMI grade is the only parameter which correlated with CMR-NR.
Furthermore CMR-NR seems to have a prognostic role,
identifying patients with a lower LVEF and higher incidence of MACE during the early period of recovery [4].
Larger study group and longer FU are needed to confirm this data and to assess if CMR-NR is a better predictor of event than angiography-NR,
in order...
References
[1] Kloner R.
No-Reflow Phenomenon: Maintaining Vascular Integrity.
Journal of Cardiovascular Pharmacology and Therapeutics 2011
[2] van ‘t Hof AW et al.
Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade.
Zwolle myocardial infarction study group.
Circulation 1998
[3] Ndrepepa G et al.
Predictive factors and impact of no reflow after primary percutaneous coronary intervention in patients with acute myocardial infarction,
Circ Cardiovasc Interv.
2010
[4] Klug G et al.
Prognostic value at 5 years of...