Moisés Jiménez-Santos

Instituto Nacional de Cardiología, Ciudad de México, The Federal District, Mexico

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Publications (8)38.34 Total impact

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    ABSTRACT: Essential hypertension is one of the main risk factors for the development of coronary artery disease (CAD). Hypertension causes endothelial dysfunction which is considered an early sign for the development of CAD. Positron emission tomography is a non-invasive imaging technique that measures myocardial blood flow (MBF), allowing us to identify patients with endothelial dysfunction. 19 patients without comorbidities recently diagnosed hypertensive, as well as 21 healthy volunteers were studied. A three-phase (rest, cold pressor test, and adenosine-induced hyperemia) (13)N-ammonia PET was performed, and MBF was measured. Endothelial-Dependent Vasodilation Index, ΔMBF, and coronary flow reserve (CFR) were calculated for each patient. Hypertensive patients had a significantly higher systolic and diastolic blood pressures compared with the control group (134.6 ± 11.7/86.4 ± 10.6 mm Hg and 106.0 ± 11.8/71.4 ± 6.6 mm Hg, respectively, P < .001). The ENDEVI (1.28 ± 0.26 vs 1.79 ± 0.30, P < .001), the ΔMBF (0.81 ± 0.50 vs 0.25 ± 0.21, P < .001) and the CFR (2.18 ± 0.88 vs 3.17 ± 0.68, P = .001) were significantly lower in the hypertensive patients compared to the control group, 84% of the former group had endothelial dysfunction i.e., ENDEVI < 1.5 and 58% had vasomotor abnormalities, i.e., CFR < 2.5. In this study, we showed that recently diagnosed hypertensive patients have coronary endothelial dysfunction and vasomotor disturbances which are early signs for the development of CAD.
    Journal of Nuclear Cardiology 06/2012; 19(5):979-86. · 2.85 Impact Factor
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    ABSTRACT: Introduction: Asynchrony induces a series of adverse effects in the heart: LV end-diastolic pressure increment, diastolic filling time decrement, ventricular relaxation delay, SV and BP decrement, favoring mitral regurgitation and leading to pathologic ventricular remodeling which further deteriorates ventricular function. Objectives: Analize LV asynchrony and its concordance with the myocardial infarction region in patients with ischemic heart disease in dilatedphase with Gated-SPECT. Methods: We studied patients with ischemic heart disease in dilatedphase with Gated-SPECT, using Cedars Sinai QPS and QPG software. Patients were distributed in 2 groups according to the concordance between the most asynchronic zone and the infarcted region. We calculated LVEF, EDV, ESV, bandwidth, SD, entropy, mean, SSS, SRS and SDS. We analized LV perfusion and synchrony of contraction with polar maps. Results: We studied 32 patients (27 men and 5 women), age 59.31�11.6 years, QRS 125.03�40.60 ms, LVEF 24.18�8.32%, EDV 244.40�87.20 ml. As well, we observed ECG conduction abnormalities in 81% of the patients (15 patients with LBBB, 11 with LAFB and 1 with RBBB). 100% of the patients presented asynchrony indexes: bandwidth 83.53�48.16°, mean 142.93�23.47°, SD 22.06�14.51°, entropy 55.09�11.57. QRS duration did not correlate with any asynchrony parameter: bandwidth (p�0.602), SD (p�0.613) and entropy (p�0.668). We observed a greatcorrelation between entropy and bandwidth (rho�0.934, p 0.005); and SD (rho�0.935, p 0.005). We didn’t find correlation between LVEF and the asynchrony parameters: bandwidth (rho�0.013, p�0.942), SD (rho�0.026, p�0.889) and entropy (rho�.016, p�0.931). There is a high concordance between the maximum delay zone and the infarcted region (78%), with no statistically significant difference if there was a transmural infarction or not (p 0.05). Conclusion: We found high concordance between the maximum delay zone and the infarcted region. Nor the QRS duration, the LVEF and the LV volumes are able to predict the presence of LV asynchrony. Entropy predicts system asynchrony effectively. Demonstrating that the maximum delay zone in the myocardial contraction corresponds with an area of infarction is of great importance because it can predict a lack of response to resyncronization therapy, when the stimulator is placed over the infarcted area.
    Circulation 05/2012; 125(19):e75. · 15.20 Impact Factor
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    ABSTRACT: Introduction: A significant correlation between autoimmune diseases and accelerated coronary atherosclerosis has been found, increasing the risk of developing cardiovascular disease. Objectives: The aim of this study was to evaluate the presence of endothelial dysfunction and myocardial ischemia in asymptomatic patients with Sistemic Lupus Erythematosus (SLE) or Primary Antiphospholipid Syndrome (PAPS) without other Coronary Artery Disease (CAD) risk factors by 13N-ammonia PET. Methods: We studied 52 patients, 16 with inactive SLE, 18 with PAPS and 18 healthy volunteers. All underwent a 3 phase (rest, Cold Pressor Test and pharmacological stress) 13N-Ammonia PET on a 64 slice PET/CT scanner. Endothelial dysfunction was evaluated with Myocardial Blood Flow Quantification (MBF, ml/g/min) from the Dynamic images, the Endothelium-dependent Vasodilation Index (ENDEVI, CPT MBF/rest MBF, normal > 1,5), %∆MBF (normal > 50%) and Coronary Flow Reserve (CFR, stress MBF/rest MBF, normal > 2,5) were calculated as Endothelial function parameters. Myocardial ischemia was evaluated by two experts in the field. Results: The mean age of the patients was 36,2 ± 9.5 years whilst the mean age of the control group was 34 ± 7 years. All of the patients were asymptomatic. Compared with the control group, the patients with SLE/PAPS had a significantly lower ENDEVI (1.18 ± 0.55 vs 1.55 ± 0.37, p = 0.015), %∆MBF (18.5 ± 43 vs 55 ± 37, p = 0.015) and a non-significant lower MFR (2.58 ± 0.81 vs 3.27 ± 0.72, p = 0.26). We found ischemia in14/34 patients (41%) in the SLE/PAPS group, all the healthy volunteers studied showed normal myocardial perfusion images. Conclusion: Like other auto-immune diseases, and mostly due to the chronic inflammatory process, patients with SLE or PAPS have Endothelial Dysfunction. Even though these patients were asymptomatic and had low risk of CV disease, 41% of them had Myocardial ischemia without overt coronary atherosclerosis. Myocardial Blood Flow quantification with PET allows us to detect patients at risk of developing CAD from the earliest stages of the disease and intervene before the development of overt Myocardial ischemia.
    Circulation 05/2012; 125(59):e52-e53. · 15.20 Impact Factor
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    ABSTRACT: Introduction: A significant correlation between autoimmune diseases and accelerated coronary atherosclerosis has been found, increasing the risk of developing cardiovascular disease. Objectives: The aim of this study was to evaluate the presence of endothelial dysfunction and myocardial ischemia in asymptomatic patients with Sistemic Lupus Erythematosus (SLE) or Primary Antiphospholipid Syndrome (PAPS) without other Coronary Artery Disease (CAD) risk factors by 13N-ammonia PET. Methods: We studied 52 patients, 16 with inactive SLE, 18 with PAPS and 18 healthy volunteers. All underwent a 3 phase (rest, Cold Pressor Test and pharmacological stress) 13N-Ammonia PET on a 64 slice PET/CT scanner. Endothelial dysfunction was evaluated with Myocardial Blood Flow Quantification (MBF, ml/g/min) from the Dynamic images, the Endothelium-dependent Vasodilation Index (ENDEVI, CPT MBF/rest MBF, normal �1,5), %�MBF (normal �50%) and Coronary Flow Reserve (CFR, stress MBF/rest MBF, normal �2,5) were calculated as Endothelial function parameters. Myocardial ischemia was evaluated by two experts in the field. Results: The mean age of the patients was 36,2 � 9.5 years whilst the mean age of the control group was 34 � 7 years. All of the patients were asymptomatic. Compared with the control group, the patients with SLE/PAPS had a significantly lower ENDEVI (1.18 � 0.55 vs 1.55 � 0.37, p � 0.015), %�MBF (18.5 � 43 vs 55 � 37, p � 0.015) and a non-significant lower MFR (2.58 � 0.81 vs 3.27 � 0.72, p � 0.26). We found ischemia in14/34 patients (41%) in the SLE/PAPS group, all the healthy volunteers studied showed normal myocardial perfusion images. Conclusion: Like other auto-immune diseases, and mostly due to the chronic inflammatory process, patients with SLE or PAPS have Endothelial Dysfunction. Even though these patients were asymptomatic and had low risk of CV disease, 41% of them had Myocardial ischemia without overt coronary atherosclerosis. Myocardial Blood Flow quantification with PET allows us to detect patients at risk of developing CAD from the earliest stages of the disease and intervene before the development of overt Myocardial ischemia.
    Circulation. 05/2012; 125(19):e52-e53.
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    Revista Espa de Cardiologia 03/2011; 64(4):255-7. · 3.20 Impact Factor
  • Aloha Meave, Moises Jimenez-Santos, Erick Alexanderson
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    ABSTRACT: Coronary CT angiography (CCTA) and cardiovascular magnetic resonance (CMR) have evolved as quite useful techniques in chronic/acute coronary artery disease evaluation. The calcium score measurement quantifies coronary artery calcium and classifies the patients into low, intermediate, and high risk of major adverse coronary events. The CCTA value resides in the high accuracy to exclude the presence of coronary artery disease. CMR allows the acquisition of images throughout the body in any tomographic plane without limitations imposed by body habitus; also, it allows to characterize cardiovascular anatomy and structure, tissue composition, right and left ventricular function, and visualize and quantify myocardial perfusion along with viability. Since the acquisition is performed with cardiac gating in both methods, the left and right ventricular function can be calculated along with valvular characterization. Both techniques provide high-value anatomical/functional information that finally will impact on the patient’s treatment and survival.
    Current Cardiovascular Imaging Reports 01/2011; 4(2):134-148.
  • Revista Espanola De Cardiologia - REV ESPAN CARDIOL. 01/2011; 64(4):255-257.
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    ABSTRACT: We undertook this study to evaluate the functional impact of coronary abnormalities in patients with suspected coronary artery disease (CAD) by means of integrated positron emission tomography (PET) and coronary computed tomography angiography (CCTA) scan obtained on a hybrid state-of-the-art PET/CT scanner. We studied 29 consecutive, patients with a clinically suspected intermediate risk for CAD, using a hybrid PET/CT 64 slice scanner. During a single scanning session, CCTA was performed for coronary anatomy evaluation, and a rest/adenosine stress (13)N-ammonia PET was performed for myocardial perfusion assessment in 3D mode with CT attenuation correction. Twenty four (82.7%) patients had atherosclerosis detected by CCTA; 15 patients had significant (≥50%) coronary stenoses and all 15 patients showed ischemia by PET; moreover, 10/15 patients had a Summed Stress Score >12.20/24 and 83.3% patients with atherosclerosis detected by CCTA showed ischemia by PET. Two of five patients with normal coronary arteries showed ischemia by PET. CCTA agreement in positive identification of PET ischemia was 91% and agreement in ruling out ischemia was 43%; PET agreement in detecting CCTA atherosclerosis was 83%, and agreement in ruling it out was 60%. We found a strong relation between significant coronary stenosis identified by CCTA and ischemia by PET. However, in cases with low-grade stenosis, PET scan can assess the functional significance of atherosclerotic abnormalities.
    Archives of medical research 11/2010; 41(8):642-8. · 1.88 Impact Factor