Caracterización del infarto de miocardio por RM.Cuantificación de parámetros morfológicos y funcionales

Esta Tesis Doctoral comprende la caracterización del infarto de miocardio evaluado mediante el uso de la resonancia magnética. Se centra en la cuantificación de los principales índices que se pueden medir a partir de las imágenes de las distintas secuencias obtenidas mediante la resonancia magnética cardiaca. El uso de esta técnica se considera en la actualidad como el método de referencia ya que permite explorar la anatomía del corazón de forma no invasiva y valorarlo de forma cualitativa, semicuantitativa y cuantitativa. El infarto de miocardio es una de las enfermedades que más mortalidad producen en el mundo. El objetivo general de esta tesis fue evaluar cuantitativamente mediante la realización de un análisis precoz tras un infarto de miocardio cuáles de los índices nos permiten predecir una fracción de eyección preservada a los seis meses del infarto agudo de miocardio con elevación del segmento ST. Los pacientes incluidos en este trabajo fueron evaluados previamente por un cardiólogo y se le realizó el protocolo de estudio de cardiopatía isquémica, cumpliendo con la Declaración Helsinki. Todos los pacientes se evaluaron de igual manera mediante un estudio de resonancia magnética cardiaca. En el sexto mes se repitió la resonancia magnética cardiaca siguiendo el mismo protocolo que en la exploración inicial. La cuantificación de las imágenes de resonancia magnética cardiaca se realizó en una estación de trabajo, utilizando el software específico QMASS MR 6.1.5. Se evaluaron los parámetros derivados de cada secuencia mediante definición manual de los bordes endocárdicos en todos los cortes. La localización de los segmentos se llevó a cabo aplicando el modelo de 17 segmentos. En conclusión el análisis cuantitativo de los diferentes índices nos permite saber con claridad cuáles de estos índices son útiles para predecir la función sistólica tardía después de un infarto de miocardio.Chaustre Mendoza, LF. (2013). Caracterización del infarto de miocardio por RM.Cuantificación de parámetros morfológicos y funcionales [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/29754TESI

La metabolómica permite un diagnóstico rápido y preciso de la isquemia miocárdica

Forteza De Los Reyes, M.; Bodi Peris, V.; Monleon Salvadó, D.; Sanchis Forés, J.; Núñez Villota, J.; Mainar Latorre, L.; Moratal Pérez, D.... (2011). La metabolómica permite un diagnóstico rápido y preciso de la isquemia miocárdica. Latido. 13(3):117-122. http://hdl.handle.net/10251/28833S11712213

Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes

[EN] Introduction and objectives: Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. Methods: Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angioplasty). During the period 2007-2008, 93 patients were treated with primary angioplasty. A propensity score matched population was also evaluated. Results: At 1-week cardiovascular magnetic resonance, pharmacoinvasive strategy and primary angioplasty patients showed a similar extent of area at risk (29 ± 15 vs. 29 ± 17%, P = .9). Non-significant differences were detected by cardiovascular magnetic resonance at 1 week and at 6 months in infarct size, salvaged myocardium, microvascular obstruction, ejection fraction, end-diastolic volume index and end-systolic volume index (P > .2 in all cases). The same trend was observed in 1-to-1 propensity score matched patients. The rate of major adverse cardiac events (death and/or re-infarction) at 1 year was 6% in pharmacoinvasive strategy and 7% in primary angioplasty patients (P = .7). Conclusions: A pharmacoinvasive strategy including thrombolysis and routine non-immediate angioplasty represents a widely available and logistically attractive approach that yields identical short-term and long-term cardiovascular magnetic resonance-derived left ventricular outcome compared to primary angioplasty. © 2010 Sociedad Española de Cardiología.The present study was supported by the "Instituto de Salud Carlos III'' (PI080128 and Heracles grants).Bodí, V.; Rumiz, E.; Merlos, P.; Nunez, J.; Lopez-Lereu, MP.; Monmeneu, JV.; Chaustre Mendoza, LF.... (2011). One-Week and 6-month cardiovascular magnetic resonance outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusión of ST-segment elevation myocardial infarction. Revista Española de Cardiología. 64(2):111-120. https://doi.org/10.1016/j.rec.2010.10.010S11112064

Prognostic implications of dipyridamole cardiac MR imaging: a prospective multicenter registry

Purpose: To evaluate dipyridamole cardiac magnetic resonance (MR) imaging in the prediction of major events (MEs) in patients with ischemic chest pain in a large multicenter registry. Materials and Methods: Institutional ethics committee approval and written informed consent were obtained. A total of 1722 patients who were undergoing cardiac MR imaging for chest pain were included. Wall motion abnormalities (WMAs) at rest, hyperemia perfusion defect (PD), late gadolinium enhancement (LGE), and inducible WMA were analyzed (abnormal if more than one abnormal segment was seen) with the 17-segment model. A cardiac MR categorization was created: category 1, no PD, LGE, or inducible WMA; category 2, PD without LGE and inducible WMA; category 3, LGE without inducible WMA; and category 4, inducible WMA. The association with ME was analyzed by using Cox proportional hazard regression multivariate models. Results: During a median follow-up period of 308 days, 61 MEs (4%) occurred (36 cardiac deaths, 25 nonfatal myocardial infarctions). MEs were associated with a greater extent of WMA, PD, LGE, and inducible WMA (P ¿ .001 for all analyses). In multivariable analyses, PD (P = .002) and inducible WMA (P = .0001) were the only cardiac MR predictors. ME rate in categories 1, 2, 3, and 4 was 2% (14 of 901 patients), 3% (six of 219 patients), 4% (15 of 409 patients), and 14% (26 of 193 patients), respectively (category 4 vs category 1, adjusted P < .001). Cardiac MR¿directed revascularization was performed in 242 patients (14%) and reduced the risk of ME in only category 4 (7% [six of 92 patients] vs 26% [26 of 101 patients], P = .0004). Conclusion: Dipyridamole cardiac MR imaging can be used to predict MEs in patients with ischemic chest pain. Patients with inducible WMA are at the highest risk for MEs and benefit the most from revascularization.Bodi, V.; Husser, O.; Sanchis, J.; Núñez, J.; Monmeneu, JV.; López-Lereu, MP.; Bosch, MJ.... (2012). Prognostic implications of dipyridamole cardiac MR imaging: a prospective multicenter registry. Radiology. 262(1):91-100. doi:10.1148/radiol.11110134S91100262

Effect of ischemic postconditioning on microvascular obstruction in reperfused myocardial infarction. Results of a randomized study in patients and of an experimental model in swine

Background: Ischemic postconditioning (PCON) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction (STEMI). We evaluated the effect of PCON on microvascular obstruction (MVO) in STEMI patients and in an experimental swine model. Methods: A prospective randomized study in patients and an experimental study in swine were carried out in two university hospitals in Spain. 101 consecutive STEMI patients were randomized to undergo primary angio-plasty followed by PCON or primary angioplasty alone (non-PCON). Using late gadolinium enhancement cardiovascular magnetic resonance, infarct size and MVO were quantified (% of left ventricular mass). In swine, using an angioplasty balloon-induced anterior STEMI model, MVO was defined as the % of area at risk without thioflavin-S staining. Results: In patients, PCON (n = 49) in comparison with non-PCON (n = 52) did not significantly reduce MVO (0 [0-1.02]% vs. 0 [0-2.1]% p = 0.2) or IS (18 +/- 13% vs. 21 +/- 14%, p = 0.2). MVO (>1 segment in the 17-segment model) occurred in 12/49 (25%) PCON and in 18/52 (35%) non-PCON patients, p = 0.3. No significant differences were observed between PCON and non-PCON patients in left ventricular volumes, ejection fraction or the extent of hemorrhage. In the swine model, MVO occurred in 4/6 (67%) PCON and in 4/6 (67%) non-PCON pigs, p = 0.9. The extent of MVO (10 +/- 7% vs. 10 +/- 8%, p = 0.9) and infarct size (23 +/- 14% vs. 24 +/- 10%, p = 0.8) was not reduced in PCON compared with non-PCON pigs. Conclusions: Ischemic postconditioning does not significantly reduce microvascular obstruction in ST-segment elevation myocardial infarction.The present study was supported by the "Instituto de Salud Carlos III" (PI1102323 grant), FEDER, the "Conselleria de Educacio, Cultura i Esport de la Generalitat Valenciana" (PROMETEO/2013/007 grant) and by the Regensburger Forschungsforderung in der Medizin (ReForM).Bodí, V.; Ruiz Nodar, JM.; Feliu, E.; Minana, G.; Nuñez, J.; Husser, O.; Martinez Elvira, J.... (2014). Effect of ischemic postconditioning on microvascular obstruction in reperfused myocardial infarction. Results of a randomized study in patients and of an experimental model in swine. International Journal of Cardiology. 175(1):138-146. https://doi.org/10.1016/j.ijcard.2014.05.003S138146175