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1.
Int J Cardiovasc Imaging ; 37(5): 1735-1744, 2021 May.
Article in English | MEDLINE | ID: mdl-33442854

ABSTRACT

Recent studies show that microvascular injury consists of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). In patients with reperfused ST-segment elevation myocardial infarction (STEMI) quantitative assessment of IMH with T2* cardiovascular magnetic resonance imaging (CMR) appears to be useful in evaluation of microvascular damage. The current study aimed to investigate feasibility of this approach and to correlate IMH with clinical and CMR parameters. A single center observational cohort study was performed in reperfused STEMI patients with CMR examination 7 days (IQR: 5 to 8 days) after percutaneous coronary intervention. Infarct size (IS) and MVO were evaluated in short-axis late gadolinium enhancement sequences and IMH with whole LV volume T2* mapping sequences. Of the 94 patients, MVO was identified in 52% of patients and the median size of MVO was 3% of LV mass (IQR: 1.5 to 5.4%). IMH was present in 28% of patients and the median size of IMH was 1.1% of LV mass (IQR: 0.5 to 2.9%). IMH extent was independently associated with anterior myocardial infarction (p = 0.022) and thrombectomy (p = 0.049). IMH was correlated with MVO (R = 0.62, p < 0.001), necrosis (R = 0.58, p < 0.001) and LVEF (R = -0.21, p = 0.04). Patients with IMH presented higher incidence of MACE events, independently of LVEF (p = 0.022). T2* mapping is a novel imaging approach that proves useful to asses IMH in the setting of reperfused STEMI. T2* IMH extent was associated with anterior infarction and thrombectomy. T2* IMH was associated with higher incidence of MACE events regardless preserved or reduced LVEF.


Subject(s)
Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Contrast Media , Gadolinium , Hemorrhage/diagnostic imaging , Hemorrhage/etiology , Humans , Magnetic Resonance Imaging , Magnetic Resonance Imaging, Cine , Percutaneous Coronary Intervention/adverse effects , Predictive Value of Tests , Prognosis , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery
4.
Eur Heart J Cardiovasc Imaging ; 17(3): 308-15, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26108417

ABSTRACT

AIMS: To assess the feasibility and incidence of immediate complications of stress cardiovascular magnetic resonance (CMR) and to determine associated factors. METHODS AND RESULTS: This was a large multicentre, prospective registry of pharmacologic stress CMR in a referral population. We used dipyridamole when no contraindication was present and dobutamine in the remaining patients. Stress CMR was performed at 1.5 T. We recorded the clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications. Stress CMR was performed in 11 984 patients (98.2% of requested), using dipyridamole in 95.4% and dobutamine in 4.6%. The study could not be performed due to claustrophobia in 0.2%. Quality was optimal in 93.4%, suboptimal in 6.2%, and poor in 0.4% of studies. Images were diagnostic in 97.6% of patients (98.7% with dipyridamole and 75.1% with dobutamine, P < 0.0001). No patient died or had acute myocardial infarction during the test. Ten patients (0.08%) had severe immediate complications, seven after dipyridamole and two after dobutamine (P = 0.062), and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia. Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (24.8%). Both were significantly more frequent when dobutamine was used. CONCLUSION: Performance of stress CMR is safe in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications. The incidence of non-severe complications and minor symptoms was greater with dobutamine.


Subject(s)
Cardiotonic Agents/adverse effects , Dipyridamole/adverse effects , Dobutamine/adverse effects , Exercise Test/adverse effects , Magnetic Resonance Imaging , Vasodilator Agents/adverse effects , Feasibility Studies , Female , Hemodynamics , Humans , Male , Middle Aged , Patient Safety , Prospective Studies , Registries , Risk Factors , Spain
5.
Heart Int ; 8(1): e3, 2013.
Article in English | MEDLINE | ID: mdl-24179637

ABSTRACT

The aim of this study was to use magnetic resonance imaging (MRI) to classify the morphological changes and remodeling of the right ventricle (RV) that occur in different clinical situations and that have an impact on RV function. Most literature has traditionally focused on the left ventricle (LV) and as a result, few studies analyze RV behavior and remodeling. The study evaluated all cardiac MRI performed at our center from 2008 to 2010. We retrospectively identified 159 patients who had some sign of right ventricular dysfunction (RVD) based on MRI findings. We classified patients according to a combination of criteria for RVD and the presence of left ventricle dysfunction (LVD). We considered RVD as any of the following abnormalities: i) depressed RV function; ii) RV dilatation; iii) RV hypertrophy. LVD was considered when there was atrial dilatation, LV hypertrophy, LV dilatation and/or depressed LV function. We obtained 6 pathophysiological patterns: RV pressure overload (1.9%), RV volume overload (15.7%), RV volume overload + LVD (32.7%), depressed RV function + LVD (42.1%), mixed RV overload + LVD (6.9%) and other (0.6%). The most frequent etiology was congenital heart disease (33.3%), followed by idiopathic dilated cardiomyopathy (18.2%), left valvular disease (17.6%), ischemic heart disease (15%), pulmonary disease (9.8%), and other (6.1%). This study helps to classify the different patterns that RV can adopt in different clinical situations and can, therefore, help us to understand the RV pathophysiology.

8.
Rev. esp. cardiol. (Ed. impr.) ; 65(6): 517-524, jun. 2012.
Article in Spanish | IBECS | ID: ibc-100252

ABSTRACT

Introducción y objetivos. Evaluar la capacidad de la tomografía computarizada con multidetectores en el diagnóstico de la disfunción ventricular izquierda de origen coronario y valorar su exactitud diagnóstica comparándola con la combinación de coronariografía invasiva y resonancia magnética. Métodos. Se estudió a 40 pacientes consecutivos con disfunción ventricular izquierda de origen no filiado mediante coronariografía invasiva y resonancia con contraste. A todos ellos se les realizó además un estudio de tomografía computarizada con multidetectores incluyendo presencia de calcio coronario y su cuantificación, coronariografía y valoración tisular del miocardio. Resultados. La sensibilidad y la especificidad de la presencia de calcio coronario para identificar la disfunción ventricular izquierda de origen coronario fueron del 100 y el 31% respectivamente. Si se considera un score de calcio por Agatston>100, la especificidad sube al 58% manteniendo la sensibilidad del 100%. Los valores de sensibilidad y especificidad de la coronariografía por tomografía computarizada con multidetectores fueron del 100 y el 96% respectivamente; para la identificación de áreas de necrosis en la adquisición precoz, del 57 y el 100% y en la adquisición tardía, del 84 y el 96%. Para identificar a los pacientes coronarios con necrosis, la sensibilidad y la especificidad fueron del 92 y el 100% respectivamente. Conclusiones. De todas las herramientas diagnósticas disponibles en tomografía computarizada con multidetectores, la coronariografía es la que muestra mayor exactitud diagnóstica para determinar el origen coronario de la disfunción ventricular. La combinación del estudio coronariográfico y el estudio tisular del miocardio tras el contraste permite obtener en un solo examen información similar a la de la combinación de cateterismo y resonancia con contraste (AU)


Introduction and objectives. To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. Methods. Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. Results. The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. Conclusions. Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , /diagnosis , Multidetector Computed Tomography/instrumentation , Multidetector Computed Tomography/methods , Multidetector Computed Tomography , Multidetector Computed Tomography/standards , Multidetector Computed Tomography/trends , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging , Sensitivity and Specificity , Prospective Studies , Statistics, Nonparametric
9.
Rev Esp Cardiol (Engl Ed) ; 65(6): 517-24, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22079180

ABSTRACT

INTRODUCTION AND OBJECTIVES: To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. METHODS: Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. RESULTS: The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. CONCLUSIONS: Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance.


Subject(s)
Calcinosis/complications , Coronary Artery Disease/complications , Ventricular Dysfunction, Left/etiology , Adult , Aged , Aged, 80 and over , Calcinosis/diagnosis , Coronary Angiography/methods , Coronary Artery Disease/diagnosis , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multidetector Computed Tomography/methods , Necrosis , Prospective Studies , Sensitivity and Specificity
10.
Rev. esp. cardiol. Supl. (Ed. impresa) ; 6(supl.E): 15e-20e, 2006. ilus
Article in Spanish | IBECS | ID: ibc-166167

ABSTRACT

Los métodos diagnósticos de imagen son importantes en la evaluación de las valvulopatías y necesarios para definir la morfología valvular, incluidos las valvas, el anillo y el aparato subvalvular, evaluar la gravedad de la afección, y obtener datos de volúmenes, función ventricular y diámetros aórticos. Con cardiorresonancia magnética (CRM), utilizando secuencias de contraste de fase, podemos medir directamente el volumen regurgitante, la velocidad pico y estimar así el gradiente a través de una estenosis. Las secuencias de cine nos permitirán una visualización privilegiada del tamaño de las cámaras cardiacas y de los jets de estenosis o regurgitación. Los volúmenes y la función ventricular pueden ser medidos de forma precisa y reproducible, lo que permite estudios de seguimiento. Revisaremos las principales técnicas que se utilizan en CRM para evaluar la función valvular, y sus ventajas y limitaciones para proporcionar información clínicamente útil en el paciente con afección valvular (AU)


Noninvasive imaging is extremely important in the assessment of a patient with valvular heart disease. It is essential for visualizing valvular morphology, including valve cusps, rings and the subvalvular apparatus, for assessing disease severity, and for providing data on ventricular dimensions and function, and aortic dimensions. With phasecontrast cardiovascular magnetic resonance, it is possible to measure regurgitant volume and peak flow velocity directly, thereby enabling the pressure gradient across a stenosis to be estimated. In addition, cardiac chambers and flow jets associated with a stenosis or regurgitation can be imaged exceptionally well using cine cardiovascular magnetic resonance. Furthermore, since ventricular dimensions and function can be measured accurately and reproducibly, it is possible to carry out follow-up studies. In this article, the main cardiovascular magnetic resonance techniques used in valve assessment are reviewed, with reference to the advantages and limitations of using cardiovascular magnetic resonance to provide clinically useful information in patients with valvular heart disease (AU)


Subject(s)
Humans , Heart Valve Diseases , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Spectroscopy/instrumentation , Aortic Valve Stenosis , Aortic Valve Insufficiency , Mitral Valve Insufficiency , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/methods
11.
Rev. esp. cardiol. Supl. (Ed. impresa) ; 6(supl.E): 41e-48e, 2006. tab, ilus, graf
Article in Spanish | IBECS | ID: ibc-166170

ABSTRACT

Mediante cardiorresonancia es posible realizar estudios de detección de isquemia miocárdica en condiciones de estrés, evaluando la perfusión miocárdica, la contractilidad miocárdica o ambas con una elevada exactitud diagnóstica. En este capítulo analizamos los protocolos de estudio, sus indicaciones y limitaciones, así como los valores diagnósticos (AU)


Stress cardiac magnetic resonance imaging is useful for detecting myocardial ischemia. The technique can be used to assess myocardial perfusion and contractility with a high degree of accuracy. In this article, we review study protocols, indications for and limitations of the technique, and the technique’s diagnostic value (AU)


Subject(s)
Humans , Myocardial Ischemia , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/instrumentation , Echocardiography, Stress/methods , Echocardiography, Stress , Angiography/methods , Dobutamine/therapeutic use , Vasodilator Agents/administration & dosage
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