María P López-Lereu

Hospital Clínico Universitario de Valencia, Valenza, Valencia, Spain

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Publications (56)251.85 Total impact

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    ABSTRACT: Cardiovascular magnetic resonance (CMR) predicts combined clinical events in post-ST-segment elevation myocardial infarction (STEMI) patients. However, its contribution to predicting long-term major events (ME: cardiac death and non-fatal myocardial infarction [MI]) is unknown. We aimed to assess whether CMR predicts long-term MEs when performed soon after STEMI.
    No preview · Article · Dec 2015
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    ABSTRACT: To assess predictors of reverse remodeling by using cardiac magnetic resonance (MR) imaging soon after ST-segment- elevation myocardial infarction (STEMI). Materials and Methods: Written informed consent was obtained from all patients, and the study protocol was approved by the institutional committee on human research, ensuring that it conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Five hundred seven patients (mean age, 58 years; age range, 24-89 years) with a first STEMI were prospectively studied. Infarct size and microvascular obstruction (MVO) were quantified at late gadolinium-enhanced imaging. Reverse remodeling was defined as a decrease in left ventricular (LV) end-systolic volume index (LVESVI) of more than 10% from 1 week to 6 months after STEMI. For statistical analysis, a simple (from a clinical perspective) multiple regression model preanalyzing infarct size and MVO were applied via univariate receiver operating characteristic techniques. Results: Patients with reverse remodeling (n = 211, 42%) had a lesser extent (percentage of LV mass) of 1-week infarct size (mean ± standard deviation: 18% ± 13 vs 23% ± 14) and MVO (median, 0% vs 0%; interquartile range, 0%-1% vs 0%-4%) than those without reverse remodeling (n = 296, 58%) (P <.001 in pairwise comparisons). The independent predictors of reverse remodeling were infarct size (odds ratio, 0.98; 95% confidence interval [CI]: 0.97, 0.99; P = .04) and MVO (odds ratio, 0.92; 95% CI: 0.86, 0.99; P = .03). Once infarct size and MVO were dichotomized by using univariate receiver operating characteristic techniques, the only independent predictor of reverse remodeling was the presence of simultaneous nonextensive infarct-size MVO (infarct size <30% of LV mass and MVO <2.5% of LV mass) (odds ratio, 3.2; 95% CI: 1.8, 5.7; P <.001). Conclusion: Assessment of infarct size and MVO with cardiac MR imaging soon after STEMI enables one to make a decision in the prediction of reverse remodeling.
    No preview · Article · Sep 2015 · Radiology
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    Ernesto Valero · Jose Antonio Ferrero · Maria Pilar López-Lereu · Francisco Javier Chorro
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    ABSTRACT: Congenital absence of the pericardium is a very uncommon finding, and its diagnosis poses a challenge because it is rarely suspected in daily clinical practice. Although in most cases it has a benign course, this congenital defect should be identified because of the associated risk of sudden death. We present a symptomatic case of partial congenital absence of the left pericardium suspected as the result of an abnormal response to exercise stress testing, and confirmed using cardiac magnetic resonance imaging. We review the current diagnostic tools and therapeutic indications of this rare anomaly. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · May 2015 · The Canadian journal of cardiology
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    ABSTRACT: The aim of this study was to establish reference values for segmental myocardial strain measured by magnetic resonance (MR) cardiac tagging in order to characterize the regional function of the heart. We characterized the left ventricular (LV) systolic deformation in 39 subjects (26 women and 13 men, age 58.8 ± 11.6 years) whose cardiological study had not revealed any significant abnormality. The deformation was measured from MR-tagged (Siemens 1.5T MR) images using an algorithm based on sine wave modeling. Circumferential and radial peak systolic strain values along with the torsion angle and circumferential-longitudinal (CL) shear were determined in 16 LV segments in order to settle the reference values for these parameters. Circumferential strain was highest at the anterior and lateral walls (-20.2 ± 4.0% and -21.8 ± 4.3%, respectively; P < 0.05) and was lowest at the base level (-17.2 ± 3.1% vs. -20.1 ± 3.1% "mid level," P < 0.05; -17.2 ± 3.1% vs. -20.3 ± 3.0% "apical level," P < 0.05). Radial strain highest values were from inferior and lateral walls (13.7 ± 7.4% and 12.8 ± 7.8%, respectively; P < 0.05) and it was lowest medially (9.4 ± 4.1% vs. 13.1 ± 4.1% "base level," P < 0.05; 9.4 ± 4.1% vs. 12.1 ± 4.4% "apical level," P < 0.05). Torsion angle (counterclockwise when viewed from the apex) increased with the distance from the base (7.9 ± 2.4° vs. 16.8 ± 4.4°, P < 0.05), and the highest and lowest values were found at lateral (medial lateral: 12.0 ± 4.4°, apical lateral: 25.1 ± 6.4°, P < 0.05) and septal wall (medial septal: 3.6 ± 2.1°, apical septal: 8.3 ± 5.3°, P < 0.05), respectively. These differences were found again in CL shear values, around the LV circumference. However, CL shear remained constant with increasing distance from the base (9.1 ± 2.6°, medium and 9.8 ± 2.4°, apex). In summary, this study provides reference values for the assessment of regional myocardial function by MR cardiac tagging. Comparison of patient deformation parameters with normal deformation patterns may permit early detection of regional systolic dysfunction.J. Magn. Reson. Imaging 2013. © 2013 Wiley Periodicals, Inc.
    No preview · Article · Jan 2015 · Journal of Magnetic Resonance Imaging

  • No preview · Article · Jan 2015 · Cardiology
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    ABSTRACT: Introduction and objectives: The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. Methods: In a multicenter registry using stress magnetic resonance, the presence (≥ 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. Results: In 391 patients, perfusion defect or late enhancement were present in 224 (57%) and 237 (61%). During follow-up (median, 96 weeks), 47 major events (12%) occurred: 25 cardiac deaths and 22 myocardial infarctions. Patients with major events displayed a larger extent of perfusion defects (6 segments vs 3 segments; P <.001) but not late enhancement (5 segments vs 3 segments; P =.1). Major event rate was significantly higher in the presence of perfusion defects (17% vs 5%; P =.0005) but not of late enhancement (14% vs 9%; P =.1). Patients were categorized into 4 groups: absence of perfusion defect and absence of late enhancement (n = 124), presence of late enhancement and absence of perfusion defect (n = 43), presence of perfusion defect and presence of late enhancement (n = 195), absence of late enhancement and presence of perfusion defect (n = 29). Event rate was 5%, 7%, 16%, and 24%, respectively (P for trend = .003). In a multivariate regression model, only perfusion defect (hazard ratio = 2.86; 95% confidence interval, 1.37-5.95]; P = .002) but not late enhancement (hazard ratio = 1.70; 95% confidence interval, 0.90-3.22; P =.105) predicted events. Conclusions: In depressed left ventricular function, the presence of inducible ischemia is the strongest predictor of major events.
    No preview · Article · Sep 2014 · Revista Espanola de Cardiologia
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    ABSTRACT: Introduction and objectives The incremental prognostic value of inducible myocardial ischemia over necrosis derived by stress cardiac magnetic resonance in depressed left ventricular function is unknown. We determined the prognostic value of necrosis and ischemia in patients with depressed left ventricular function referred for dipyridamole stress perfusion magnetic resonance. Methods In a multicenter registry using stress magnetic resonance, the presence (≥ 2 segments) of late enhancement and perfusion defects and their association with major events (cardiac death and nonfatal infarction) was determined. Results In 391 patients, perfusion defect or late enhancement were present in 224 (57%) and 237 (61%). During follow-up (median, 96 weeks), 47 major events (12%) occurred: 25 cardiac deaths and 22 myocardial infarctions. Patients with major events displayed a larger extent of perfusion defects (6 segments vs 3 segments; P <.001) but not late enhancement (5 segments vs 3 segments; P =.1). Major event rate was significantly higher in the presence of perfusion defects (17% vs 5%; P =.0005) but not of late enhancement (14% vs 9%; P =.1). Patients were categorized into 4 groups: absence of perfusion defect and absence of late enhancement (n = 124), presence of late enhancement and absence of perfusion defect (n = 43), presence of perfusion defect and presence of late enhancement (n = 195), absence of late enhancement and presence of perfusion defect (n = 29). Event rate was 5%, 7%, 16%, and 24%, respectively (P for trend = .003). In a multivariate regression model, only perfusion defect (hazard ratio = 2.86; 95% confidence interval, 1.37-5.95]; P = .002) but not late enhancement (hazard ratio = 1.70; 95% confidence interval, 0.90–3.22; P =.105) predicted events. Conclusions In depressed left ventricular function, the presence of inducible ischemia is the strongest predictor of major events. Full English text available from:www.revespcardiol.org/en
    No preview · Article · Sep 2014 · Revista Espa de Cardiologia
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    ABSTRACT: 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 angioplasty 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. Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT01898546.
    No preview · Article · Jul 2014
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    ABSTRACT: 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 angioplasty 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. Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT01898546.
    No preview · Article · May 2014 · International Journal of Cardiology
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    ABSTRACT: Purpose: With the advent of percutaneous transcatheter device closures in congenital heart defects and the emergence of percutaneous left atrial appendage closure, there is an increasingly important role for echocardiographic guidance and control of device position and function. Disc occluder devices frequently present as an unexplained ‘figure-of-8’ on echocardiography. The aim of this study was to clarify this ‘figure-of-8’ display and to relate its morphology to transducer position and device type. Methods: A mathematical model was developed to resemble disc occluder geometry and to allow a numerical simulation of the echocardiographic appearance. In addition, we developed an in vitro set-up for echocardiographic analysis of various disc occluders and various transducer positions. Results: In the mathematical model of an epitrochoid curve (closely resembling disc occluder geometry) a ‘figure-of-8’ display is obtained when emphasizing points with tangent vector perpendicular to the direction of ultrasound waves. Decreasing imaging depth results in a more asymmetric ‘figure-of-8’, with small upper part and wide lower part. Clinical and in vitro data are in close agreement with these results (Figure 1). Furthermore a ‘figure-of-8’ display is only obtained in a coronal imaging position, and is similar for different commercially available disc occluder types. Conclusions: The ‘figure-of-8’ display in the ultrasound image of a disc occluder is an imaging artifact due to the specific ‘epitrochoidal’ geometry of a deployed device and its interaction with ultrasound waves. The morphology of the ‘figure-of-8’ depends on transducer position, i.e. imaging depth, and is similar for different device types.
    Full-text · Poster · Dec 2013
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    ABSTRACT: Purpose: Left atrial (LA) function includes reservoir, conduit and booster pump functions. In stiff ventricles these change in order to improve the filling. The aim of the study was to assess these changes in hypertensive patients (HT) with cardiovascular magnetic resonance (CMR). Methods: HT subjects referred for a clinical CMR and who did not have signs of myocardial necrosis, no cardiomyopathy except HT, no significant valve disease and no signs of secondary HT were included and compared to matched normotensives (NT). Cine sequences were acquired in a short axis stack of the atria and ventricles. LA volumes (maximum= LAmax, pre-atrial contraction= LAa, minimum= LAmin) were quantified. Several parameters were calculated for reservoir function (expansion index= (LAmax-LAmin)*100/LAmin; total emptying fraction= (LAmax-LAmin)*100/LAmax), conduit function (passive emptying percentage = (LAmax-LAa)*100/(LAmax-LAmin); passive emptying fraction= (LAmax-LAa)*100/LAmax) and pump function (active emptying percentage = (LAa-LAmin)*100/(LAmax-LAmin); active emptying fraction= (LAa-LAmin)*100/LAa). Differences regarding these parameters were tested with ANOVA (factors: group, age, gender, BSA). Correlations with age and LV mass were explored. Results: 35 hypertensives (22 males, 35-80yrs) were included. They showed a significant decrease in parameters of reservoir and conduit functions, while the active emptying percentage was significantly increased. Results are shown on the table. Age correlated with LA volumes (LAmax, r= 0.48; LAa, r= 0.50; LAmin, r= 0.52), but not with LA function. LV mass was inversely correlated with parameters of reservoir function (expansion index, r= -0.597; total emptying fraction, r= -0.532) and relative wall mass was found to be inversely correlated with active emptying fraction (r= -0.464). View this table:Enlarge table
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Objectives: Longstanding systemic hypertension (HT) may cause significant dilatation of the aorta. Our objective was to quantify with cardiovascular magnetic resonance (CMR) the effect of HT on aortic dimensions. Methods: Consecutive patients who attended the CMR unit between Jan'08 and Jan'12, and did not have evidence of myocardial necrosis, cardiomyopathies other than HT, significant aortic valve disease, congenital aortic disease and secondary hypertension were included and classified according to presence (H) or absence (N) of HT. The CMR protocol included high resolution cine sequences to obtain specific planes perpendicular to the aortic long axis for each aortic segment. Aortic diameters and areas were measured in end-systole at the annulus, sinus portion, sinotubular junction, tubular portion, middle arch and descending aorta. All were indexed to body surface area. Left ventricular parameters were also recorded as well as complete clinical data. Results: 1411 patients were included, 787 H (49% males, 65±10 yrs), 624 N (63% males, 54±16yrs). ANOVA test was done (factors: group H/N, gender, BSA, age). Per-group analysis: H patients showed a significantly increased dimension at the tubular portion (H: 18,7±0,08 cm2/m2 vs N: 18,1±0,09 cm2/m2, p< 0,001), which correlated with left ventricular mass index (p<0,01). No differences were found for other segments. Per-patient analysis: group H had a higher percentage of dilatation in all segments. Lineal regression analysis showed that the presence of HT caused a mean increase of 0,6 mm/m2 in the diameter of the tubular portion.
    Preview · Article · Aug 2013 · European Heart Journal
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    ABSTRACT: Purpose: 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). Methods: 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). Results: During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6[4-9] vs. 3[1-5], p<0.0001) and a larger SS at 6 months (5[2-6] vs. 3[1-5], p=.005) than those without MACE: at 1. Late MACE rates in IS > median were higher at 1 week (14% vs. 4%, p=0.007) and in SS > median at 6 months (12% vs. 5%, p=0.053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (0.720 vs. 0.746, p=0.1). Only ETLE at 1 week (HR 1.31 95% CI [1.14-1.52], p<0.0001, per segment) independently predicted late MACE.
    Full-text · Article · Jun 2013 · The international journal of cardiovascular imaging
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    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-text · Article · May 2013 · Revista Espa de Cardiologia
  • Clara Bonanad · Jose Vicente Monmeneu · Maria Pilar López-Lereu

    No preview · Article · May 2013 · Heart, Lung and Circulation

  • No preview · Article · Jan 2013 · Cardiology
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    ABSTRACT: Purpose: Repaired tetralogy of Fallot (rtoF) patients are at risk of atrial or ventricular tachyarrhythmia and sudden cardiac death. We investigated the significance of right atrial (RA) and right ventricular (RV) anatomy and function for arrhythmia prediction by cardiac magnetic resonance imaging (CMR). Methods: One-hundred-and-fifty-four rtoF adults who underwent CMR were studied with the pre-specified endpoint of new-onset atrial or ventricular arrhythmia (sustained ventricular tachycardia/ventricular fibrillation) during a longitudinal follow-up. Results: Median age was 31 (IQR:22-40), median follow-up was 5.6 (IQR:4.6-7.0) years Atrial tachyarrhythmia (n=11) was predicted by maximal right atrial area indexed to body surface area (RAAi) on cine-CMR (Hazard ratio; HR1.17, 95%CI 1.07-1.28 per cm2/m2; P=0.0005, survival ROC curve analysis, area under curve; AUC 0.74[0.66-0.81]; cut-off value 16cm2/m2). Atrial arrhythmia-free survival was reduced in patients with RAAi ≥16cm2/m2 (Logrank; P=0.0001). RV restrictive physiology on echocardiography (n=38) related to higher RAAi (P=0.02) but did not predict atrial tachyarrhythmia (P=0.057). RV restrictive physiology patients had similar RV dilatation and exercise impairment to remaining patients representing a different phenotype from previous reports. Ventricular arrhythmia (n=9) was predicted by CMR RV outflow tract (RVOT) akinetic area length (HR1.05,95%CI 1.01-1.09 per mm; P=0.003, survival ROC analysis, AUC 0.77[0.83-0.61];cut-off value 30mm) and decreased RV ejection fraction (HR0.93 95%CI 0.87-0.99 per %; P=0.03, respectively). Ventricular arrhythmia-free survival was reduced in patients with RVOT akinetic region length >30mm (Logrank; P=0.02). Conclusions: RAAi predicts atrial arrhythmia and RVOT akinetic region length predicts ventricular arrhythmia in late follow-up of rtoF. These are simple, feasible measurements for serial surveillance and risk stratification of rtoF patients.
    Full-text · Article · Dec 2012 · European Heart Journal Cardiovascular Imaging
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    ABSTRACT: Introduction and objectivesTo 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.Methods 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.ResultsMyocardial 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).Conclusions 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.Full English text available from:www.revespcardiol.org
    No preview · Article · Jul 2012 · Revista Espa de Cardiologia
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    ABSTRACT: Background: T2 weighted cardiovascular magnetic resonance (CMR) can detect intramyocardial hemorrhage (IMH) after ST-elevation myocardial infarction (STEMI). The long-term prognostic value of IMH beyond a comprehensive CMR assessment with late enhancement (LE) imaging including microvascular obstruction (MVO) is unclear. The value of CMR-derived IMH for predicting major adverse cardiac events (MACE) and adverse cardiac remodeling after STEMI and its relationship with MVO was analyzed. Methods: CMR including LE and T2 sequences was performed in 304 patients 1 week after STEMI. Adverse remodeling was defined as dilated left ventricular end-systolic volume indexes (dLVESV) at 6 months CMR. Results: During a median follow-up of 140 weeks, 47 MACE (10 cardiac deaths, 16 myocardial infarctions, 21 heart failure episodes) occurred. Predictors of MACE were ejection fraction (HR .95 95% CI [.93-.97], p=.001, per %) and IMH (HR 1.17 95% CI [1.03-1.33], p=.01, per segment). The extent of MVO and IMH significantly correlated (r=.951, p<.0001). dLVESV was present in 40% of patients. CMR predictors of dLVESV were: LVESV (OR 1.11 95% CI [1.07-1.15], p<.0001, per ml/m(2)), infarct size (OR 1.05 95% CI [1.01-1.09], p=.02, per %) and IMH (OR 1.54 95% CI [1.15-2.07], p=.004, per segment). Addition of T2 information did not improve the LE and cine CMR-model for predicting MACE (.744 95% CI [.659-.829] vs. .734 95% CI [.650-.818], p=.6) or dLVESV (.914 95% CI [.875-.952] vs. .913 95% CI [.875-.952], p=.9). Conclusions: IMH after STEMI predicts MACE and adverse remodeling. Nevertheless, with a strong interrelation with MVO, the addition of T2 imaging does not improve the predictive value of LE-CMR.
    No preview · Article · Jun 2012 · International journal of cardiology
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    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.
    No preview · Article · May 2012 · Revista Espanola de Cardiologia