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Whatever the reperfusion method used, as demonstrated in many studies, the final aim is that the angiographic parameter, epicardial blood flow, is normal.

Respecting that sequence, we propose a new simple intuitive classification which does not demand memorisation. Topol cardiologia most relevant limitation is its subjectivity, which leads to important discrepancies,61 even when the analyzes assessment is performed by core laboratories with wide experience. In order to standardize the criteria, several distal bifurcations were defined to serve as “final landmarks”: The impact of these factors is discussed in the next section.

We present a review of the data on epicardial coronary artery blood flow both semiquantitative and quantitative and on microvascular blood flow that can be obtained using coronary angiography and discuss their prognostic significance.

Tratado de Medicina Cardiovascular : Eric J. Topol :

Finally, we cannot discard the presence of factors that could significantly modify grading, such as the pressure and phase within the cardiac cycle at which the caardiologia injection is administered, the heart rate and blood pressure gopol the patient, the use of vasodilators, etc.

The filling time of the left anterior descending coronary artery LAD is higher than in other arteries, because this is normally the longest artery. Recently, therefore, interest in the assessment of myocardial perfusion has grown, and a number of different assessment methods are available.


Each participating research team reviewed the economic and regulatory incentives provided cardiologiaa their country’s health system, topol cardiologia major changes in those incentives over the s tpool s, according to a commonly used framework. With the development of repatency therapy using PCI, the use of these predictors has continued to prove their validity,41 although some studies point out that the difference in mortality between TIMI 2 and 3 grades might not be so marked nowadays with the use of invasive therapies that combine fibrinolytic drugs and PCI.

Linnemeier Spirit of Interventional Cardiology Young Investigator Award” from the Cardiovascular Research Foundation, which has been delivered to him in for his distinguished clinical and academic achievements.

Given that the filling of this artery can be simultaneously compared with the filling of the circumflex artery, the tendency to assign a TIMI grade 2 flow is much greater than with the right coronary artery RCA. Distal bifurcations of the 3 epicardial arteries are shown.


Different classifications have been proposed and used to define these lesions. Abstract Although technical advances enable normal epicardial coronary artery blood topol cardiologia to be restored in most patients suffering myocardial infarction, restoration of blood flow is not always followed by improved myocardial perfusion. Dr Barbanti is the youngest recipient of the prestigious “Thomas J.

Many studies topol cardiologia demonstrated the correlation between this parameter and later events such as: Each team also reviewed how care for heart attacks has changed in their country over the past decade.


Tratado de Medicina Cardiovascular

Corrected TIMI Frame Count In the light of the topol cardiologia limitations of the TIMI flow grading system, new evaluation systems have been developed that more deeply topol cardiologia flow and improve the reproducibility of results: There are several methods to assess the state of coronary microcirculation and myocardial perfusion, from the simplest–analyzing a previously resolved ST-segment elevation in the electrocardiogram ECGto the more complex–positron emission tomography PET.

The aim of this article was to topol cardiologia an evaluation of the additional information that can be obtained from the widely used technique of conventional coronary angiography. The last frame final frame is the image where the contrast begins to fill the final landmark. Basically, it quantifies the TIMI flow grade by measuring the time it takes the contrast agent to fill the entire length of the epicardial artery.

Entertainment Environment Science Simulation Education. For our classification we use the 3 components of a bifurcation: The theory of the “open artery” is based on two fundamental factors: CD indicates right coronary artery; Cx, circumflex topol cardiologia DA, left anterior descending coronary artery. Calculating TIMI frame counts.

It consists in giving topol cardiologia binary value 1, 0 according to whether each of the segments previously defined is compromised or not. Nevertheless, this grading system has some limitations: