Noninvasive assessment of myocardial damage after acute anterior myocardial infarction: myocardial blush grade in conjunction with analysis of coronary flow pattern

In patients with acute myocardial infarction (AMI), both myocardial blush grade (MBG) and coronary flow pattern obtained by transthoracic Doppler echocardiography (TTDE) have limitations in assessing myocardial viability. Accordingly, we assessed the usefulness of combination of MBG and TTDE in predicting myocardial damage following AMI. A total of 45 patients with anterior AMI were enrolled. Myocardial blush grade and coronary flow velocity (CFV), diastolic deceleration time (DDT), and coronary flow velocity reserve (CFVR) were measured immediately after reperfusion. The regional wall motion score index (RWMSI) was measured at 14 days after onset. The MBG was normal in 12 patients. The RWMSI was significantly better in the patients with normal than with abnormal MBG (1.65 ± 0.29 vs 2.03 ± 0.46, P < 0.05). Among the coronary flow indices, only DDT showed the significant correlation with RWMSI (P < 0.05, r = −0.44). To predict RWMSI ≥2, sensitivity and positive predictive value (PPV) were 86.3% and 65.5% in DDT alone, 90.9% and 65.5% in MBG alone, respectively. Predictable value was enhanced by the combination with DDT and MBG, with sensitivity of 100% and PPV of 70.8% in 31 patients whose results of both corresponded. MBG in conjunction with TTDE was useful in predicting myocardial damage after anterior AMI.