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Bodi V, Gavara J, Lopez-Lereu MP, Monmeneu JV, de Dios E, Perez-Sole N, Bonanad C, Marcos-Garces V, Canoves J, Minana G, Nunez J, Moratal D, Chorro FJ, Rodríguez-Palomares JF, Freixa A, Borrás R, Ortiz-Pérez JT, Rios-Navarro C. Impact of Persistent Microvascular Obstruction Late After STEMI on Adverse LV Remodeling: A CMR Study. JACC Cardiovasc Imaging 2023:S1936-878X(23)00094-3. [PMID: 37052556 DOI: 10.1016/j.jcmg.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Little is known about the occurrence and implications of persistent microvascular obstruction (MVO) after reperfused ST-segment elevation myocardial infarction (STEMI). OBJECTIVES The authors used cardiac magnetic resonance (CMR) to characterize the impact of persistent MVO on adverse left ventricular remodeling (ALVR). METHODS A prospective registry of 471 STEMI patients underwent CMR 7 (IQR: 5-10) days and 198 (IQR: 167-231) days after infarction. MVO (≥1 segment) and ALVR (relative increase >15% at follow-up CMR) of left ventricular end-diastolic index (LVEDVI) and left ventricular end-systolic volume index (LVESVI) were determined. RESULTS One-week MVO occurred in 209 patients (44%) and persisted in 30 (6%). Extent of MVO (P = 0.026) and intramyocardial hemorrhage (P = 0.001) at 1 week were independently associated with the magnitude of MVO at follow-up CMR. Compared with patients without MVO (n = 262, 56%) or with MVO only at 1 week (n = 179, 38%), those with persistent MVO at follow-up (n = 30, 6%) showed higher rates of ALVR-LVEDVI (22%, 27%, 50%; P = 0.003) and ALVR-LVESVI (20%, 21%, 53%; P < 0.001). After adjustment, persistent MVO at follow-up (≥1 segment) was independently associated with ΔLVEDVI (relative increase, %) (P < 0.001) and ΔLVESVI (P < 0.001). Compared with a 1:1 propensity score-matched population on CMR variables made up of 30 patients with MVO only at 1 week, patients with persistent MVO more frequently displayed ALVR-LVEDVI (12% vs 50%; P = 0.003) and ALVR-LVESVI (12% vs 53%; P = 0.001). CONCLUSIONS MVO persists in a small percentage of patients in chronic phase after STEMI and exerts deleterious effects in terms of LV remodeling. These findings fuel the need for further research on microvascular injury repair.
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Affiliation(s)
- Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
| | - Jose Gavara
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | | | - Jose V Monmeneu
- Cardiovascular Magnetic Resonance Unit, Grupo ASCIRES, Valencia, Spain
| | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Nerea Perez-Sole
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Victor Marcos-Garces
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Joaquim Canoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain; Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain; Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jose F Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Freixa
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Roger Borrás
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain; Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Cesar Rios-Navarro
- Instituto de Investigación Sanitaria del Hospital Clínico Universitario de Valencia, Valencia, Spain
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Ríos-Navarro C, Gavara J, Bodí V. Microvascular injury after acute myocardial infarction. Focus on the catheterization laboratory. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:777-779. [PMID: 35676174 DOI: 10.1016/j.rec.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - José Gavara
- Centro de Biomateriales e Ingeniería Tisular, Universidad Politécnica de Valencia, Valencia, Spain
| | - Vicente Bodí
- INCLIVA - Instituto de Investigación Sanitaria, Valencia, Spain; Departamento de Medicina, Universidad de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Valencia, Spain.
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Zaragoza C, Saura M, Ramírez-Carracedo R. Cardiac microvasculature and adverse remodeling after acute myocardial infarction. New evidence on the use of VEGF as a therapeutic target. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:124-125. [PMID: 33077412 DOI: 10.1016/j.rec.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Carlos Zaragoza
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Investigación Cardiovascular, Universidad Francisco de Vitoria/Servicio de Cardiología, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain.
| | - Marta Saura
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Sistemas/Fisiología, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Rafael Ramírez-Carracedo
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Investigación Cardiovascular, Universidad Francisco de Vitoria/Servicio de Cardiología, Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, Spain
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