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Oliver Husser, Jose V Monmeneu,
Clara Bonanad,
Cristina Gomez,
Fabian Chaustre,
Julio Nunez,
Maria P Lopez-Lereu,
Gema Minana,
Juan Sanchis,
Luis Mainar,
Vicente Ruiz,
Maria J Forteza,
Isabel Trapero,
David Moratal,
Francisco J Chorro,
Vicente Bodi
[show abstract]
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ABSTRACT: Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4-9] vs. 3 [1-5], p < .0001) and a larger SS at 6 months (5 [2-6] vs. 3 [1-5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14-1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.
The international journal of cardiovascular imaging 06/2013; · 2.15 Impact Factor
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Pilar Merlos,
Maria P López-Lereu, Jose V Monmeneu,
Juan Sanchis,
Julio Núñez,
Clara Bonanad,
Ernesto Valero,
Gema Miñana,
Fabián Chaustre,
Cristina Gómez,
Ricardo Oltra,
Lorena Palacios,
Maria J Bosch,
Vicente Navarro,
Angel Llácer,
Francisco J Chorro,
Vicente Bodí
[show abstract]
[hide abstract]
ABSTRACT: INTRODUCTION AND OBJECTIVES: A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. METHODS: One week after a first ST-segment elevation myocardial infarction we carried out a comprehensive quantification of several resonance parameters in 206 consecutive patients. A semiquantitative assessment (altered number of segments in the 17-segment model) of edema, baseline and post-dobutamine wall motion abnormalities, first pass perfusion, microvascular obstruction, and the extent of transmural necrosis was also performed. RESULTS: During follow-up (median 51 months), 29 patients suffered a major adverse cardiac event (8 cardiac deaths, 11 nonfatal myocardial infarctions, and 10 readmissions for heart failure). Major cardiac events were associated with more severely altered quantitative and semiquantitative resonance indexes. After a comprehensive multivariate adjustment, the extent of transmural necrosis was the only resonance index independently related to the major cardiac event rate (hazard ratio=1.34 [1.19-1.51] per each additional segment displaying >50% transmural necrosis, P<.001). CONCLUSIONS: A simple and non-time consuming semiquantitative analysis of the extent of transmural necrosis is the most powerful cardiac magnetic resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction. Full English text available from: www.revespcardiol.org/en.
Revista Espa de Cardiologia 05/2013; · 2.53 Impact Factor
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José V Monmeneu,
Vicente Bodí,
María P López-Lereu,
Juan Sanchis,
Julio Núñez,
Fabián Chaustre,
Oliver Husser,
Pilar Merlos,
Clara Bonanad,
Gema Miñana,
Francisco J Chorro,
Angel Llácer
[show abstract]
[hide abstract]
ABSTRACT: To evaluate by cardiovascular magnetic resonance those factors related to the amount of salvaged myocardium after a myocardial infarction and its value in predicting adverse ventricular remodeling.
One hundred eighteen patients admitted for a first ST elevation myocardial infarction (primary angioplasty, 65 patients; a pharmacoinvasive strategy, 53 patients) underwent magnetic resonance (6 [5-8] days and 6 months; n=83). The myocardial salvage index was quantitatively assessed as the percentage of area at risk (T2-weighted sequences) not showing late enhancement.
Myocardial salvage index >31% (median) was associated with a shorter time to reperfusion (153 min vs 258 min), a lower rate of diabetes (12% vs 32%), shorter time to magnetic resonance, and better cardiovascular parameters (P<.05 for all analyses). There were no significant differences depending on the reperfusion method. In a logistic regression analysis, delayed reperfusion (odds ratio=0.42 [0.29-0.63]; P<.0001), diabetes (odds ratio=0.32 [0.11-0.99]; P<.05) and a longer time to the performance of magnetic resonance (odds ratio=0.86 [0.76-0.97]; P<.05) were independently related to a lower probability of a myocardial salvage index >31%. Predictors of increased left ventricular end-systolic volume at 6 months were the number of segments showing an extent of transmural necrosis >50% (odds ratio =1.51 [1.21-1.90]; P<.0001) and left ventricular end-systolic volume at one week (odds ratio=1.12 [1.06-1.18]; P<.0001).
Cardiovascular magnetic resonance enables the quantification of the salvaged myocardium after myocardial infarction. The celerity with which reperfusion therapy is administered constitutes its most important predictor. The possible effect of a delay in the performance of magnetic resonance on myocardial salvage needs to be confirmed. Salvaged myocardium does not improve the value of magnetic resonance for predicting adverse remodeling.
Revista Espanola de Cardiologia 05/2012; 65(7):634-41.
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Vicente Bodi,
Oliver Husser,
Juan Sanchis,
Julio Núñez, José V Monmeneu,
María P López-Lereu,
María J Bosch,
Eva Rumiz,
Gema Miñana,
Carlos García,
José L Diago,
Fabián Chaustre,
David Moratal,
Cristina Gómez,
José Aguilar,
Francisco J Chorro,
Angel Llacer
[show abstract]
[hide abstract]
ABSTRACT: 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.
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.
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).
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.
Radiology 11/2011; 262(1):91-100. · 5.73 Impact Factor
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Vicente Bodí,
Eva Rumiz,
Pilar Merlos,
Julio Nunez,
Maria P López-Lereu, José V Monmeneu,
Fabián Chaustre,
David Moratal,
Isabel Trapero,
Maria L Blasco,
Ricardo Oltra,
Rafael Sanjuán,
Francisco J Chorro,
Angel Llàcer,
Juan Sanchis
[show abstract]
[hide abstract]
ABSTRACT: 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.
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.
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).
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.
Revista Espa de Cardiologia 02/2011; 64(2):111-20. · 2.53 Impact Factor
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Vicente Bodí,
Oliver Husser,
Juan Sanchis,
Julio Núñez,
María P López-Lereu, José V Monmeneu,
Luis Mainar,
Fabian Chaustre,
Günter A J Riegger,
María J Bosch,
Francisco J Chorro,
Angel Llácer
[show abstract]
[hide abstract]
ABSTRACT: To perform a comparison of cardiac magnetic resonance (MR) imaging-derived ejection fraction (EF) during low-dose dobutamine infusion (EF(D)) with the extent of segments with transmural necrosis in more than 50% of their wall thickness (ETN) for the prediction of major adverse cardiac events (MACEs) and late systolic recovery soon after a first ST-segment elevation myocardial infarction (STEMI).
Institutional ethics committee approval and written informed consent were obtained. One hundred nineteen consecutive patients with a first STEMI, a depressed left ventricular EF, and an open infarct-related artery underwent MR imaging at 1 week after infarction. EF(D) and ETN (by using a 17-segment model) were determined, and the prediction of MACEs and systolic recovery at follow-up was assessed by using area under the receiver operating characteristic curve (AUC) and multivariable regression analysis.
During follow-up (median, 613 days; range, 312-1243 days), 18 MACEs (five cardiac deaths, six myocardial infarctions, seven readmissions for heart failure) occurred. MACEs were associated with a lower EF(D) (43% +/- 12 [standard deviation] vs 49% +/- 10, P = .02) and a larger ETN (seven segments +/- three vs four segments +/- three, P < .001). Patients with systolic recovery (increase in EF of >5% at follow-up compared with baseline EF, n = 44) displayed a higher EF(D) (51% +/- 10 vs 47% +/- 9, P = .04) and a smaller ETN (three segments +/- two vs five segments +/- three, P = .002) at 1 week. ETN and EF(D) both related to MACEs (AUC: 0.78 vs 0.67, respectively, P = .1) and systolic recovery (AUC: 0.68 vs 0.62, respectively, P = .3). According to multivariable analysis, ETN was the only MR variable associated with time to MACEs (hazard ratio, 1.38; 95% confidence interval: 1.19, 1.60; P < .001) and systolic recovery (odds ratio, 0.76; 95% confidence interval: 0.64, 0.92; P = .004) independent of baseline characteristics.
ETN is as useful as EF(D) for the prediction of MACEs and systolic recovery soon after STEMI.
Radiology 06/2010; 255(3):755-63. · 5.73 Impact Factor
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Vicente Bodí,
Juan Sanchis,
Julio Núñez,
Eva Rumiza,
Luis Mainar,
María P López-Lereu, José V Monmeneu,
Ricardo Oltra,
María J Forteza,
Francisco J Chorro,
Angel Llácer
[show abstract]
[hide abstract]
ABSTRACT: The presence of microvascular obstruction after ST-segment elevation acute myocardial infarction is associated with a poor outcome. The pathophysiology of this process has not been fully defined. The aim of this study was to investigate the relationship between post-reperfusion lymphopenia and microvascular obstruction.
This prospective study involved 212 patients with a first ST-segment elevation acute myocardial infarction who underwent reperfusion with thrombolytic agents or primary angioplasty and who had an open infarct-related artery. Serial measurements of lymphocyte, neutrophil and monocyte counts were taken. Cardiac magnetic resonance was used to detect microvascular obstruction during the first week after the infarction. Imaging was repeated 6 months after infarction.
Microvascular obstruction was observed in 67 patients (32%). A post-reperfusion lymphocyte count <1800 cells/ml was associated with a higher risk of microvascular obstruction (44% versus 20%; P< .001) as well as with a low left ventricular ejection fraction and large left ventricular volumes (P< .05). After adjustment for baseline characteristics, ECG findings, necrosis marker levels and angiographic variables, multivariate analysis showed that a post-reperfusion lymphocyte count <1800 cells/ml was independently associated with an increased risk of microvascular obstruction (odds ratio=3.2; 95% confidence interval 1.6-6.3; P< .001).
In ST-segment elevation myocardial infarction, post-reperfusion lymphopenia is an early and powerful predictor of the presence of microvascular obstruction. The pathophysiological and therapeutic implications of this association require further study.
Revista Espa de Cardiologia 10/2009; 62(10):1109-17. · 2.53 Impact Factor
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[show abstract]
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ABSTRACT: The aims of the study were to characterize myocardial edema after ST-elevation acute myocardial infarction using cardiac magnetic resonance imaging and to investigate its impact on ventricular function and its subsequent evolution.
In total, 134 patients admitted to hospital for a first ST-elevation myocardial infarction who had a patent infarct-related artery underwent cardiac magnetic resonance imaging. Cine images (at rest and with low-dose dobutamine) and edema, perfusion and viability images were acquired. Imaging was repeated after 6 months.
In the first week after infarction, edema was detected in at least one segment in 96.6% of patients (4+/-2.1 segments per patient). Extensive edema (> or = 4 segments) was associated with large ventricular end-diastolic and end-systolic volumes (P< .0001), a small left ventricular ejection fraction at rest (P=.001) and with low-dose dobutamine (P=.006), a large number of segments showing hypoperfusion (P=.001) or microvascular obstruction (P=.009), a more extensive infarct (P=.017) and greater transmural extent of the infarct (P=.003). The association between the presence and extent of edema during the first week and functional, perfusion and viability variables was still observable after 6 months. No patient exhibited edema at 6 months.
Cardiac magnetic resonance imaging was useful for characterizing the myocardial edema that occurred after ST-elevation acute myocardial infarction. Extensive edema was associated with poor left ventricular characteristics. Edema was a transitory phenomenon that vanished within 6 months.
Revista Espa de Cardiologia 09/2009; 62(8):858-66. · 2.53 Impact Factor
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Revista Espa de Cardiologia 05/2009; 62(4):461-2. · 2.53 Impact Factor
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Oliver Husser,
Vicente Bodí,
Juan Sanchís,
Luis Mainar,
Julio Núñez,
María P López-Lereu, José V Monmeneu,
Vicente Ruiz,
Eva Rumiz,
David Moratal,
Francisco J Chorro,
Angel Llácer
[show abstract]
[hide abstract]
ABSTRACT: Dipyridamole stress perfusion cardiovascular magnetic resonance (CMR) is used to detect coronary artery disease (CAD). However, few data are available on the diagnostic value of the systolic dysfunction induced by dipyridamole. This study investigated whether the induction of systolic dysfunction supplements the diagnostic information provided by perfusion imaging in the detection of CAD.
Overall, 166 patients underwent dipyridamole CMR and quantitative coronary angiography, with CAD being defined as a stenosis > or =70%. Systolic dysfunction at rest, systolic dysfunction with dipyridamole, induced systolic dysfunction, and stress first-pass perfussion deficit (PD) and delayed enhancement were quantified.
In the multivariate analysis, PD (hazard ratio [HR]=1.6; 95% confidence interval [CI], 1.33-1.91;P< .0001) and induced systolic dysfunction (OR=1.8; 95% CI, 1.18-2.28; P< .007) were independently associated with CAD and had a sensitivity and specificity of 92% and 62% and 43% and 96%, respectively. Patients were categorized as having no ischemia (Group 1), PD but no induced systolic dysfunction (Group 2), or induced systolic dysfunction irrespective of PD (Group 3). In Group 3, the prevalence of CAD was higher than in Group 1 or 2 (96% vs. 22% and 79%, respectively; P=.001) and the risk of CAD was two-fold higher than in Group 2 (OR=2.34; 95% CI, 1.07-5.13; P=.034). Compared with Group 2, more hypoperfused segments were observed in Group 3 (6.2+/-2.6 vs. 7.4+/-3.4; P=.044), and more diseased vessels (1.4+/-1.0 vs. 1.8+/-0.9; P=.036). Adding induced systolic dysfunction to perfusion and clinical data improved the multivariate model's C-statistic for predicting CAD (0.81 vs. 0.87; P=.02).
Combining induced systolic dysfunction with perfusion imaging increases the diagnostic accuracy of detecting CAD and enables patients with severe ischemia and a high probability of CAD to be identified.
Revista Espa de Cardiologia 04/2009; 62(4):383-91. · 2.53 Impact Factor
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Oliver Husser,
Vicente Bodí,
Juan Sanchís,
Luis Mainar,
Julio Núñez,
María P. López-Lereu, José V. Monmeneu,
Vicente Ruiz,
Eva Rumiz,
David Moratal,
Francisco J. Chorro,
Ángel Llácera
Revista Espanola De Cardiologia - REV ESPAN CARDIOL. 01/2009; 62(4):383-391.
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[show abstract]
[hide abstract]
ABSTRACT: Tumor necrosis factor-alpha is an inflammatory cytokine which rises in heart failure and has prognostic value in severe cases. Its value is less established in moderate cases. Our aim was to determine its prognostic value in cases from a community hospital.
We studied 50 patients, average age 59.5 12.3 years, with dilated cardiomyopathy (72% non-ischemic) and moderate heart failure (59% functional class II).
Patients were evaluated with an echocardiogram and cardiopulmonary treadmill stress test (Naughton), muscular strength measurements (hand dynamometer), blood tumor necrosis factor levels, and an average follow-up of 17.5 9 months (range, 1-29 months). All causes of mortality, cardiac transplantation, and readmissions for heart failure were recorded.
Twenty-three patients experienced events. These patients were older (63 +/- 12.7 vs 55.7 +/- 11.4 years; p = 0.042), had a lower peak VO2 (13.7 +/- 3.9 vs 16 +/- 3.3 ml/kg/min; p = 0.035), and higher peak VE/VCO2 and factor levels [41.9 +/- 10.6 vs 33.2 +/- 5.7; p = 0.001 and 4.3 (3.1-7.9) vs 3.3 (2.4-4.3) pg/ml; p = 0.021, respectively]. In the Cox model, the only variable with independent prognostic value was peak VE/VCO2 [HR 1.13 (1.07-1.19); p < 0.001]. The best cutoff point was 34.5 (sensitivity, 86.4%; specificity, 58.3%; p = 0.0007). The cytokine had no independent prognostic value.
Our patients with events were older, had a lower peak VO2, and higher peak VE/VCO2 and serum tumor necrosis factor levels. However, only peak VE/VCO2 had independent prognostic value.
Revista Espa de Cardiologia 02/2003; 56(2):160-7. · 2.53 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The activity questionnaire most frequently used in heart failure, the New York Heart Association Classification, does not correlate well with peak oxygen uptake. The correlation of this variable with other activity questionnaires was analyzed in 83 patients (69 with heart failure and 14 control patients), 61.5 11 years old, who were interviewed and classified according to the Canadian Cardiovascular Society Classification. The Dyspnea-Fatigue Index and functional capacity according to the Specific Activity Questionnaire were determined for each patient. Subsequently, the treadmill cardiopulmonary exercise test (Naughton) was performed and the following correlations with peak oxygen uptake were found: Canadian Cardiovascular Society, r = 0.39; Dyspnea-Fatigue Index, r = 0.44; Specific Activity Questionnaire, r = 0.38. p < 0.001 for all three. The Dyspnea-Fatigue Index yielded the best correlation, although it was only slightly better than the Canadian Cardiovascular Society Classification, which is easier to obtain.
Revista Espa de Cardiologia 01/2003; 56(1):100-3. · 2.53 Impact Factor
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Juan Sanchis,
Vicent Bodí,
Alejandro Navarro,
Angel Llácer,
Marisa Blasco,
Luis Mainar, José V Monmeneu,
Luis Insa,
José A Ferrero,
Francisco J Chorro,
Rafael Sanjuán
[show abstract]
[hide abstract]
ABSTRACT: The prognosis of unstable angina varies between series depending on the inclusion criteria and management protocol used. The aim of this study was to analyze in-hospital events and their predictors in a homogeneous single-center series of patients with unstable angina.
A total of 246 patients with the following inclusion criteria were studied: 1) resting anginal pain, 2) transient electrocardiographic changes during anginal pain, 3) normal CK-MB levels and 4) exclusion of postinfarction angina. All patients were treated with aspirin and enoxaparin (1 mg/kg/12 h). Coronary angiography was performed in the case of recurrent angina or ischemia in Bruce I-II stage during the predischarge effort stress test. The variables recorded were risk factors, history of ischemic heart disease, history of coronary surgery, ECG upon admission, and fibrinogen.
During the hospital stay the following events were recorded: 36% recurrent angina, 58% cardiac catheterization, and 5,7% major events (infarction or death). Multivariate analysis found recurrent angina to be more frequent in patients with a history of coronary bypass surgery (p = 0.004. OR = 22; CI 95%, 3-182), ST-segment changes (p = 0.01. OR = 4.7, CI 95%; 1.4-15.9) and higher fibrinogen (p = 0.002. OR = 1,4, CI 95%; 1.1-1.7). Fibrinogen was the only variable related to cardiac catheterization (p = 0,009. OR = 1.3. CI 95%, 1.1-1.6) and major events (p = 0.001. OR = 2.0. CI 95%, 1.4-3.1).
1) Unstable angina with electrocardiographic changes was associated to a high rate of in-hospital events. 2) Fibrinogen was related to any event, and previous by-pass surgery and ST changes were related to recurrent angina.
Revista Espa de Cardiologia 10/2002; 55(9):921-7. · 2.53 Impact Factor
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Vicent Bodí,
Lorenzo Facila,
Juan Sanchis,
Angel Llácer,
Julio Núñez,
Luis Mainar,
Ricardo Gómez-Aldaraví, José V Monmeneu,
María L Blasco,
Rafael Sanjuan,
Luis Insa,
Francisco J Chorro
[show abstract]
[hide abstract]
ABSTRACT: The relative value of classic markers, myocardial damage variables, and levels of acute-phase reactants in establishing the pre-discharge prognosis of acute coronary syndrome without ST-segment elevation was analyzed.
We prospectively studied 385 consecutive patients admitted from our chest pain unit with a high-probability diagnosis of acute coronary syndrome without ST-segment elevation. The clinical and electrocardiographic data, myocardial damage markers (troponin I, CK-Mb mass, myoglobin), and acute-phase reactants (high-sensitivity C-reactive protein, fibrinogen) were recorded.
During admission, 15 deaths (3.9%) and 16 complicative infarctions (4.2%) occurred, for a total of 31 major events (death and/or infarction: 8.1%). Age (p = 0.03), insulin-dependent diabetes (p = 0.009), and C-reactive protein (p = 0.05) were independently related to death. Fibrinogen was related to infarction (p = 0.01); by fibrinogen quartiles: 1.4%; 1.4%; 2.9%, and 11.7% (p = 0.02). Age (p = 0.01), insulin-dependent diabetes (p = 0.02), and C-reactive protein (p = 0.04) were independent predictors of major events; by C-reactive protein quartiles: 1.4%; 5.5%; 5.4%, and 16.7% (p = 0.004). Troponin I was related to major events (p = 0.03), but it was not an independent predictor.
Acute-phase reactants add independent information to clinical variables in the short-term risk stratification of patients with an acute coronary syndrome. The predictive power of troponins is lower than that of other variables.
Revista Espa de Cardiologia 09/2002; 55(8):823-30. · 2.53 Impact Factor
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Vicent Bodí,
Lorenzo Facila,
Juan Sanchis,
Ángel Llácer,
Julio Núñez,
Luis Mainar,
Ricardo Gómez-Aldaraví, José V Monmeneu,
María L Blasco,
Rafael Sanjuan,
Luis Insa,
Francisco J Chorro
[show abstract]
[hide abstract]
ABSTRACT: Objectives. The relative value of classic markers, myocardial damage variables, and levels of acute-phase reactants in establishing the pre-discharge prognosis of acute coronary syndrome without ST-segment elevation was analyzed. Method. We prospectively studied 385 consecutive patients admitted from our chest pain unit with a high-probability diagnosis of acute coronary syndrome without ST-segment elevation. The clinical and electrocardiographic data, myocardial damage markers (troponin I, CK-Mb mass, myoglobin), and acute-phase reactants (high-sensitivity C-reactive protein, fibrinogen) were recorded. Results. During admission, 15 deaths (3.9%) and 16 complicative infarctions (4.2%) occurred, for a total of 31 major events (death and/or infarction: 8.1%). Age (p = 0.03), insulin-dependent diabetes (p = 0.009), and C-reactive protein (p = 0.05) were independently related to death. Fibrinogen was related to infarction (p = 0.01); by fibrinogen quartiles: 1.4%; 1.4%; 2.9%, and 11.7% (p = 0.02). Age (p = 0.01), insulin-dependent diabetes (p = 0.02), and C-reactive protein (p = 0.04) were independent predictors of major events; by C-reactive protein quartiles: 1.4%; 5.5%; 5.4%, and 16.7% (p = 0.004). Troponin I was related to major events (p = 0.03), but it was not an independent predictor. Conclusions. Acute-phase reactants add independent information to clinical variables in the short-term risk stratification of patients with an acute coronary syndrome. The predictive power of troponins is lower than that of other variables. Pronóstico a corto plazo de los pacientes ingresados por probable síndrome coronario agudo sin elevación del segmento ST. Papel de los nuevos marcadores de daño miocárdico y de los reactantes de fase aguda Objetivos. Se analiza el papel relativo de los marcadores clásicos, de las variables de daño miocárdico y reactantes de fase aguda en el pronóstico prealta del síndrome coronario agudo sin elevación del segmento ST. Método. Se estudió prospectivamente a 385 pacientes consecutivos ingresados desde nuestra unidad de dolor torácico con el diagnóstico de alta probabilidad de síndrome coronario agudo sin elevación del segmento ST. Se recogieron las variables clínicas, electrocardiográficas, indicadores de daño miocárdico (troponina I, Ck-Mb masa, mioglobina) y reactantes de fase aguda (proteína C reactiva de alta sensibilidad y fibrinógeno). Resultados. Durante el ingreso hospitalario se detectaron 15 fallecimientos (3,9%), 16 infartos complicativos (4,2%) y 31 episodios mayores (fallecimiento y/o infarto: 8,1%). Fueron predictores independientes de fallecimiento la edad (p = 0,03), la diabetes insulinodependiente (p = 0,009) y la proteína C reactiva (p = 0,05). El fibrinógeno (p = 0,01) predijo infarto; por cuartiles: 1,4; 1,4; 2,9, y 11,7% (p = 0,02). La edad (p = 0,01), la diabetes insulinodependiente (p = 0,02) y la proteína C reactiva (p = 0,04) fueron predictores independientes de episodio mayor; por cuartiles de proteína C reactiva: 1,4; 5,5; 5,4, y 16,7% (p = 0,004). La troponina I se relacionó con una mayor tasa de episodios mayores (p = 0,03), pero no fue un predictor independiente. Conclusiones. Los reactantes de fase aguda añaden información independiente a las variables clínicas en la estratificación de riesgo a corto plazo de los pacientes con síndrome coronario agudo. El poder predictor de la troponina disminuye al ser comparado con otras variables.
51 Rev Esp Cardiol. 01/2002;
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Vicente Bodí,
Juan Sanchis,
Julio Núñez,
Eva Rumiz,
Luis Mainar,
María P. López-Lereu, José V. Monmeneu,
Ricardo Oltra,
María J. Forteza,
Francisco J. Chorro,
Àngel Llácer
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ABSTRACT: Introduction and objectivesThe presence of microvascular obstruction after ST-segment elevation acute myocardial infarction is associated with a poor outcome. The pathophysiology of this process has not been fully defined. The aim of this study was to investigate the relationship between post-reperfusion lymphopenia and microvascular obstruction.MethodsThis prospective study involved 212 patients with a first ST-segment elevation acute myocardial infarction who underwent reperfusion with thrombolytic agents or primary angioplasty and who had an open infarct-related artery. Serial measurements of lymphocyte, neutrophil, and monocyte counts were taken. Cardiac magnetic resonance was used to detect microvascular obstruction during the first week after the infarction. Imaging was repeated 6 months after infarction.ResultsMicrovascular obstruction was observed in 67 patients (32%). A post-reperfusion lymphocyte count <1800 cells/mL was associated with a higher risk of microvascular obstruction (44% vs 20%; P<.001) as well as with a low left ventricular ejection fraction and large left ventricular volumes (P<.05). After adjustment for baseline characteristics, ECG findings, necrosis marker levels, and angiographic variables, multivariate analysis showed that a post-reperfusion lymphocyte count <1800 cells/mL was independently associated with an increased risk of microvascular obstruction (odds ratio = 3.2; 95% confidence interval, 1.6-6.3; P<.001).ConclusionsIn ST-segment elevation myocardial infarction, post-reperfusion lymphopenia is an early and powerful predictor of the presence of microvascular obstruction. The pathophysiological and therapeutic implications of this association require further study.Introducción y objetivosLa obstrucción microvascular tras un infarto agudo de miocardio con elevación del segmento ST se asocia a mal pronóstico. La fisiopatología de este fenómeno no está totalmente definida. Analizamos las implicaciones de la linfopenia post-reperfusión en la existencia de obstrucción microvascular.MétodosEstudiamos prospectivamente a 212 pacientes que habían sufrido un primer infarto agudo de miocardio con elevación del segmento ST reperfundido con agentes trombolíticos o con angioplastia primaria y con la arteria responsable abierta. Cuantificamos de manera seriada las cifras de linfocitos, neutrófilos y monocitos. Usamos la resonancia magnética cardiaca para determinar la existencia de obstrucción microvascular en la primera semana post-infarto. Se repitió el estudio a los 6 meses del infarto.ResultadosDetectamos obstrucción microvascular en 67 (32%) pacientes. Observamos que una cifra de linfocitos post-reperfusión < 1.800 células/ml se asociaba a un riesgo alto de obstrucción microvascular (el 44 frente al 20%; p < 0,001), así como menor fracción de eyección y volúmenes de ventrículo izquierdo mayores (p < 0,05). En el estudio multivariado ajustado por las características basales, electrocardiograma, marcadores de necrosis y variables angiográficas, una cifra de linfocitos postreperfusión < 1.800 células/ml incrementó de manera independiente el riesgo de obstrucción microvascular (odds ratio = 3,2 [1,6-6,3]; p < 0,001).ConclusionesEn el infarto de miocardio con elevación del segmento ST, la linfopenia post-reperfusión es un predictor precoz y potente de la existencia de obstrucción microvascular. Las posibles implicaciones fisiopatológicas y terapéuticas de esta asociación requieren más estudios.
Revista Española de Cardiología (English Edition).
