TIMI flow grade 4

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: TIMI 4, TIMI 4 flow, TIMI 4 flow grade, TFG 4, TFG4, hyperemia, hyperemic flow

Overview

TIMI grade 4 flow is a term developed by Dr. C. Michael Gibson, M.S., M.D. to describe hyperemic flow on a coronary arteriogram.[1] Hyperemic flow on a coronary arteriogram is defined qualitatitively as near instantaneous filling of the coronary artery with dye, and quantitatively as a corrected TIMI frame count < 14 frames. Hyperemic flow in a coronary artery may be due to either repayment of oxygen debt following ischemia due to a balloon inflation for instance, or distal embolization. If it is due to distal embolization, and if impaired myocardial perfusion is present (TIMI myocardial perfusion grade 0 or TIMI myocardial perfusion grade 1), then the mortality associated with TIMI grade 4 flow is actually higher than that of TIMI grade 3 flow.[1] In this scenario, the hyperemic flow is a surrogate or marker of endogenous adenosine release due to distal embolization, rather than being causally related to adverse outcomes.

References

  1. 1.0 1.1 Gibson CM, Pride YB, Buros JL, Kunadian V, Southard MC, Harrigan CJ; et al. (2008). "Relation of hyperemic epicardial flow to outcomes among patients with ST-segment elevation myocardial infarction receiving fibrinolytic therapy.". Am J Cardiol. 101 (9): 1232–8. PMID 18435949. doi:10.1016/j.amjcard.2007.12.023. 

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