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Updated: Jun 14, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Quantitative myocardial blush grade for the detection of cardiac allograft vasculopathy
Grigorios Korosoglou1, Nina Riedle, Markus Erbacher
1University of Heidelberg, Department of Cardiology, Heidelberg, Germany. gkorosoglou@hotmail.com
Insights
Quantitative myocardial blush grade (MBG) can detect early cardiac allograft vasculopathy (CAV) in heart transplant recipients. This method improves the identification of microvascular dysfunction, aiding in early intervention for CAV.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Imaging
Background:
- Cardiac allograft vasculopathy (CAV) is a major complication after heart transplantation (HTx), impairing microvascular function.
- Early detection of CAV is crucial for recipient outcomes.
Purpose of the Study:
- To evaluate the efficacy of quantitative myocardial blush grade (MBG) in detecting CAV in HTx recipients.
- To compare quantitative MBG with traditional methods for CAV assessment.
Main Methods:
- Quantitative MBG (G(max)/T(max)) was assessed in 72 HTx recipients during surveillance cardiac catheterization.
- Cardiac magnetic resonance imaging was used to evaluate diastolic strain rates and myocardial perfusion reserve.
- Correlations between quantitative MBG, perfusion reserve, and diastolic function were analyzed.
Main Results:
- Quantitative MBG (G(max)/T(max)) significantly correlated with perfusion reserve and diastolic strain rates.
- Quantitative MBG demonstrated higher accuracy (AUC=0.91) than coronary angiograms (AUC=0.78) in detecting impaired microvascular integrity.
- Quantitative MBG provided a more robust prediction of survival compared to visual MBG and coronary lumen narrowing.
Conclusions:
- Quantification of MBG is feasible using coronary angiograms in HTx recipients.
- Quantitative MBG can identify early CAV, particularly in patients with impaired perfusion reserve but without evident atherosclerosis.
- This method offers a valuable tool for early CAV detection and patient management.
Background:
Cardiac allograft vasculopathy (CAV) progressively compromises microvascular perfusion and function in heart transplantation (HTx)-recipients. The aim of our study was to investigate the ability of quantitative myocardial blush grade (MBG) to detect CAV.
Methods:
In consecutive HTx-recipients (n = 72) who underwent surveillance cardiac catheterization, MBG was assessed visually and quantitatively, by analyzing the time course of contrast agent intensity rise. Hereby, the parameter G(max)/T(max) was calculated as the plateau of grey-level intensity (G(max)) divided by the time-to-peak intensity (T(max)). HTx-recipients and 18 healthy volunteers underwent cardiac magnetic resonance, to assess diastolic strain rates and myocardial perfusion reserve during pharmacologic hyperemia.
Results:
Significant correlations were observed between G(max)/T(max) with perfusion reserve and with mean diastolic strain rates (r(2) = 0.68 and r(2) = 0.58, P < .001 for both). Visual and quantitative MBG using a cutoff value of G(max)/T(max) = 2.7/s yielded significantly higher accuracy than stenosis severity on coronary angiograms for the detection of impaired microvascular integrity as a surrogate marker for CAV (AUC = 0.78, SE = 0.06, 95% CI = 0.66-0.87 for lumen narrowing versus AUC = 0.91, SE = 0.03, 95%CI = 0.84-0.97 for G(max)/T(max); P < .01). Furthermore, quantitative MBG provided more robust prediction of survival (chi(2)= 14.0, P < .001), compared to visually estimated blush (chi(2)= 5.4, P = .02) and to coronary lumen narrowing assessment, (chi(2)= 4.8, P = .04).
Conclusions:
Quantification of MBG can be performed on coronary angiograms of HTx-recipients, and may help with the identification of early CAV in patients with impaired perfusion reserve but without angiographically evident atherosclerosis.
