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Panagiotides NG, Poledniczek M, Andreas M, Hülsmann M, Kocher AA, Kopp CW, Piechota-Polanczyk A, Weidenhammer A, Pavo N, Wadowski PP. Myocardial Oedema as a Consequence of Viral Infection and Persistence-A Narrative Review with Focus on COVID-19 and Post COVID Sequelae. Viruses 2024; 16:121. [PMID: 38257821 PMCID: PMC10818479 DOI: 10.3390/v16010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Microvascular integrity is a critical factor in myocardial fluid homeostasis. The subtle equilibrium between capillary filtration and lymphatic fluid removal is disturbed during pathological processes leading to inflammation, but also in hypoxia or due to alterations in vascular perfusion and coagulability. The degradation of the glycocalyx as the main component of the endothelial filtration barrier as well as pericyte disintegration results in the accumulation of interstitial and intracellular water. Moreover, lymphatic dysfunction evokes an increase in metabolic waste products, cytokines and inflammatory cells in the interstitial space contributing to myocardial oedema formation. This leads to myocardial stiffness and impaired contractility, eventually resulting in cardiomyocyte apoptosis, myocardial remodelling and fibrosis. The following article reviews pathophysiological inflammatory processes leading to myocardial oedema including myocarditis, ischaemia-reperfusion injury and viral infections with a special focus on the pathomechanisms evoked by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In addition, clinical implications including potential long-term effects due to viral persistence (long COVID), as well as treatment options, are discussed.
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Affiliation(s)
- Noel G. Panagiotides
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (M.P.); (M.H.); (A.W.); (N.P.)
| | - Michael Poledniczek
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (M.P.); (M.H.); (A.W.); (N.P.)
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria;
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.A.); (A.A.K.)
| | - Martin Hülsmann
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (M.P.); (M.H.); (A.W.); (N.P.)
| | - Alfred A. Kocher
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria; (M.A.); (A.A.K.)
| | - Christoph W. Kopp
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria;
| | | | - Annika Weidenhammer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (M.P.); (M.H.); (A.W.); (N.P.)
| | - Noemi Pavo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (M.P.); (M.H.); (A.W.); (N.P.)
| | - Patricia P. Wadowski
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria;
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Vasques‐Nóvoa F, Angélico‐Gonçalves A, Alvarenga JM, Nobrega J, Cerqueira RJ, Mancio J, Leite‐Moreira AF, Roncon‐Albuquerque R. Myocardial oedema: pathophysiological basis and implications for the failing heart. ESC Heart Fail 2022; 9:958-976. [PMID: 35150087 PMCID: PMC8934951 DOI: 10.1002/ehf2.13775] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/27/2021] [Accepted: 12/02/2021] [Indexed: 12/04/2022] Open
Abstract
Myocardial fluid homeostasis relies on a complex interplay between microvascular filtration, interstitial hydration, cardiomyocyte water uptake and lymphatic removal. Dysregulation of one or more of these mechanisms may result in myocardial oedema. Interstitial and intracellular fluid accumulation disrupts myocardial architecture, intercellular communication, and metabolic pathways, decreasing contractility and increasing myocardial stiffness. The widespread use of cardiac magnetic resonance enabled the identification of myocardial oedema as a clinically relevant imaging finding with prognostic implications in several types of heart failure. Furthermore, growing experimental evidence has contributed to a better understanding of the physical and molecular interactions in the microvascular barrier, myocardial interstitium and lymphatics and how they might be disrupted in heart failure. In this review, we summarize current knowledge on the factors controlling myocardial water balance in the healthy and failing heart and pinpoint the new potential therapeutic avenues.
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Affiliation(s)
- Francisco Vasques‐Nóvoa
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
| | - António Angélico‐Gonçalves
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
| | - José M.G. Alvarenga
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
| | - João Nobrega
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
| | - Rui J. Cerqueira
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
| | - Jennifer Mancio
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
| | - Adelino F. Leite‐Moreira
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
| | - Roberto Roncon‐Albuquerque
- Cardiovascular R&D Center, Faculty of MedicineUniversity of PortoPortoPortugal
- Department of Surgery and Physiology, Faculty of MedicineUniversity of PortoAl. Prof. Hernâni MonteiroPorto4200‐319Portugal
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de Dios E, Rios-Navarro C, Perez-Sole N, Gavara J, Marcos-Garces V, Rodríguez E, Carratalá A, Forner MJ, Navarro J, Blasco ML, Bondia E, Signes-Costa J, Vila JM, Forteza MJ, Chorro FJ, Bodi V. Similar Clinical Course and Significance of Circulating Innate and Adaptive Immune Cell Counts in STEMI and COVID-19. J Clin Med 2020; 9:jcm9113484. [PMID: 33126723 PMCID: PMC7692467 DOI: 10.3390/jcm9113484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower minimum lymphocyte counts were associated with more events and more severe organ damage. NLR was higher in STEMI and COVID-19 patients with the worst clinical and structural outcomes. A canonical deregulation of the immune response occurs in STEMI and COVID-19 patients. Boosted circulating innate (neutrophilia) and depressed circulating adaptive immunity (lymphopenia) is associated with more events and severe organ damage. A greater understanding of these critical illnesses is pivotal to explore novel alternative therapies.
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Affiliation(s)
- Elena de Dios
- Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), 28029 Madrid, Spain; (E.d.D.); (F.J.C.)
- Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
| | - Cesar Rios-Navarro
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
| | - Nerea Perez-Sole
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
| | - Jose Gavara
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
| | | | - Enrique Rodríguez
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Biochemical Department, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Arturo Carratalá
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Biochemical Department, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Maria J. Forner
- Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Internal Medicine Department, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Jorge Navarro
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Medical Directory, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Maria L. Blasco
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Medical Intensive Care Unit, Hospital Clínico Universitario, 46010 Valencia, Spain
| | - Elvira Bondia
- Pneumology Service, Hospital Clínico Universitario, 46010 Valencia, Spain;
| | - Jaime Signes-Costa
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Pneumology Service, Hospital Clínico Universitario, 46010 Valencia, Spain;
| | - Jose M. Vila
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Physiology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
| | - Maria J. Forteza
- Cardiovascular Medicine Unit, Center of Molecular Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, 171 77 Stockholm, Sweden;
| | - Francisco J. Chorro
- Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), 28029 Madrid, Spain; (E.d.D.); (F.J.C.)
- Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, Spain;
| | - Vicente Bodi
- Centro de Investigación Biomédica en Red-Cardiovascular (CIBER-CV), 28029 Madrid, Spain; (E.d.D.); (F.J.C.)
- Medicine Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain;
- Institute of Health Research-INCLIVA, 46010 Valencia, Spain; (C.R.-N.); (N.P.-S.); (J.G.); (E.R.); (A.C.); (J.N.); (M.L.B.); (J.S.-C.); (J.M.V.)
- Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, Spain;
- Correspondence: ; Tel.: +34-96-197-3523
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Larroza A, Materka A, López-Lereu MP, Monmeneu JV, Bodí V, Moratal D. Differentiation between acute and chronic myocardial infarction by means of texture analysis of late gadolinium enhancement and cine cardiac magnetic resonance imaging. Eur J Radiol 2017. [PMID: 28624024 DOI: 10.1016/j.ejrad.2017.04.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to differentiate acute from chronic myocardial infarction using machine learning techniques and texture features extracted from cardiac magnetic resonance imaging (MRI). The study group comprised 22 cases with acute myocardial infarction (AMI) and 22 cases with chronic myocardial infarction (CMI). Cine and late gadolinium enhancement (LGE) MRI were analyzed independently to differentiate AMI from CMI. A total of 279 texture features were extracted from predefined regions of interest (ROIs): the infarcted area on LGE MRI, and the entire myocardium on cine MRI. Classification performance was evaluated by a nested cross-validation approach combining a feature selection technique with three predictive models: random forest, support vector machine (SVM) with Gaussian Kernel, and SVM with polynomial kernel. The polynomial SVM yielded the best classification performance. Receiver operating characteristic curves provided area-under-the-curve (AUC) (mean±standard deviation) of 0.86±0.06 on LGE MRI using 72 features; AMI sensitivity=0.81±0.08 and specificity=0.84±0.09. On cine MRI, AUC=0.82±0.06 using 75 features; AMI sensitivity=0.79±0.10 and specificity=0.80±0.10. We concluded that texture analysis can be used for differentiation of AMI from CMI on cardiac LGE MRI, and also on standard cine sequences in which the infarction is visually imperceptible in most cases.
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Affiliation(s)
- Andrés Larroza
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Andrzej Materka
- Institute of Electronics, Technical University of Lodz, Lodz, Poland
| | | | | | - Vicente Bodí
- Department of Medicine, Universitat de València, Valencia, Spain.
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain.
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Hamshere S, Jones DA, Pellaton C, Longchamp D, Burchell T, Mohiddin S, Moon JC, Kastrup J, Locca D, Petersen SE, Westwood M, Mathur A. Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary? J Cardiovasc Magn Reson 2016; 18:7. [PMID: 26803468 PMCID: PMC4724400 DOI: 10.1186/s12968-016-0226-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR). METHODS CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers. RESULTS 85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21%, 95% limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs. (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001. CONCLUSIONS AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians.
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Affiliation(s)
- Stephen Hamshere
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Cyril Pellaton
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Danielle Longchamp
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Tom Burchell
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Saidi Mohiddin
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Jens Kastrup
- Department of Cardiology, Rigshopitale, University of Copenhagen, Copenhagen, Denmark.
| | - Didier Locca
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- Service de Cardiologie et Département de Médecine Interne, Centre Hospitalier Universitaire, Vaudois, Lausanne, Switzerland.
| | - Steffen E Petersen
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Mark Westwood
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Merlos P, López-Lereu MP, Monmeneu JV, Sanchis J, Núñez J, Bonanad C, Valero E, Miñana G, Chaustre F, Gómez C, Oltra R, Palacios L, Bosch MJ, Navarro V, Llácer A, Chorro FJ, Bodí V. Long-term prognostic value of a comprehensive assessment of cardiac magnetic resonance indexes after an ST-segment elevation myocardial infarction. ACTA ACUST UNITED AC 2014; 66:613-22. [PMID: 24776329 DOI: 10.1016/j.rec.2013.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/10/2013] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Pilar Merlos
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | | | - Jose V Monmeneu
- Unidad de Resonancia Magnética Cardiaca, ERESA, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Ernesto Valero
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Fabián Chaustre
- Centro de Biomateriales e Ingeniería Tisular, Universidad Politécnica de Valencia, Valencia, Spain
| | - Cristina Gómez
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Ricardo Oltra
- Unidad de Cuidados Intensivos, Hospital Clínico Universitario, Valencia, Spain
| | - Lorena Palacios
- Unidad de Cuidados Intensivos, Hospital Clínico Universitario, Valencia, Spain
| | - Maria J Bosch
- Unidad de Cardiología, Hospital de La Plana, Villarreal, Castellón, Spain
| | - Vicente Navarro
- Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Angel Llácer
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Francisco J Chorro
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Vicente Bodí
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain.
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Valor pronóstico a largo plazo del análisis completo de los índices de resonancia magnética cardiaca tras un infarto de miocardio con elevación del segmento ST. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Head-to-head comparison of 1 week versus 6 months CMR-derived infarct size for prediction of late events after STEMI. Int J Cardiovasc Imaging 2013; 29:1499-509. [PMID: 23733237 DOI: 10.1007/s10554-013-0239-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/15/2013] [Indexed: 12/21/2022]
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.
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Cuantificación del área miocárdica en riesgo: validación de puntuaciones angiográficas coronarias con métodos de resonancia magnética cardiovascular. Rev Esp Cardiol 2012; 65:1010-7. [DOI: 10.1016/j.recesp.2012.04.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 04/13/2012] [Indexed: 11/17/2022]
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Cardiovascular magnetic resonance-derived intramyocardial hemorrhage after STEMI: Influence on long-term prognosis, adverse left ventricular remodeling and relationship with microvascular obstruction. Int J Cardiol 2012; 167:2047-54. [PMID: 22682700 DOI: 10.1016/j.ijcard.2012.05.055] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 04/04/2012] [Accepted: 05/11/2012] [Indexed: 01/03/2023]
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.
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Analysis of post-infarction salvaged myocardium by cardiac magnetic resonance. Predictors and influence on adverse ventricular remodeling. Rev Esp Cardiol 2012; 65:634-41. [PMID: 22579424 DOI: 10.1016/j.recesp.2012.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 01/29/2012] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES 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. 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. RESULTS 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). 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.
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Garcia-Dorado D, Andres-Villarreal M, Ruiz-Meana M, Inserte J, Barba I. Myocardial edema: A translational view. J Mol Cell Cardiol 2012; 52:931-9. [DOI: 10.1016/j.yjmcc.2012.01.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/09/2012] [Accepted: 01/10/2012] [Indexed: 12/21/2022]
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Husser O, Bodí V, Sanchis J, Núnez J, Mainar L, Rumiz E, López-Lereu MP, Monmeneu J, Chaustre F, Trapero I, Forteza MJ, Riegger GAJ, Chorro FJ, Llàcer A. The sum of ST-segment elevation is the best predictor of microvascular obstruction in patients treated successfully by primary percutaneous coronary intervention. Cardiovascular magnetic resonance study. Rev Esp Cardiol 2011. [PMID: 20875354 DOI: 10.1016/s0300-8932(10)70246-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES The usefulness of ST-segment elevation resolution (STR) for predicting epicardial reperfusion is well established. However, it is still not clear how ST-segment changes are related to microvascular obstruction (MVO) observed by cardiovascular magnetic resonance (CMR) after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). METHODS The study involved 85 consecutive patients admitted for a first STEMI and treated by pPCI who had a patent infarct-related artery. An ECG was recorded on admission and 90 min and 6, 24, 48 and 96 h after pPCI. Thereafter, STR and the sum of ST-segment elevation (sumSTE) in all leads were determined. RESULTS Overall, CMR revealed MVO in 37 patients. In infarcts with MVO, sumSTE was greater both before and after revascularization than in infarcts without MVO (P≤.001 at all times). In contrast, there was no significant difference in the magnitude of STR between infarcts with and without MVO 90 min after revascularization (P=.1), though there was after 6 h (P< .05 at all times). The area under the receiver operating characteristic curve for detecting MVO was greater for sumSTE than STR (P< .05 for all measurements). On multivariate analysis, after adjusting for clinical, angiographic and ECG characteristics, a sumSTE >3 mm 90 min after pPCI was an independent predictor of MVO on CMR, while an STR ≥70% was not (odds ratio=3.1; 95% confidence interval, 1.2-8.4; P=.02). CONCLUSIONS MVO was associated with a significantly increased sumSTE at all times after revascularization. The difference in the magnitude of STR between infarcts with and without MVO was significant only >6 h after revascularization. The best predictor of MVO was a sumSTE >3 mm 90 min after pPCI.
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Affiliation(s)
- Oliver Husser
- Departamento de Cardiología, Hospital Clínico y Universitario, INCLIVA, Universidad de Valencia, Valencia, España
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Freixa X, Heras M, Ortiz JT, Argiró S, Guasch E, Doltra A, Jiménez M, Betriu A, Masotti M. Utilidad de la determinación de endotelina-1 en el infarto agudo de miocardio. Rev Esp Cardiol 2011; 64:105-10. [DOI: 10.1016/j.recesp.2010.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 07/29/2010] [Indexed: 11/15/2022]
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Resultados de la estrategia farmacoinvasiva y de la angioplastia primaria en la reperfusión del infarto con elevación del segmento ST. Estudio con resonancia magnética cardiaca en la primera semana y en el sexto mes. Rev Esp Cardiol 2011; 64:111-20. [DOI: 10.1016/j.recesp.2010.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/15/2010] [Indexed: 11/23/2022]
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Bodi V, Sanchis J, Mainar L, Chorro FJ, Nunez J, Monmeneu JV, Chaustre F, Forteza MJ, Ruiz-Sauri A, Lopez-Lereu MP, Gomez C, Noguera I, Diaz A, Giner F, Llacer A. Right ventricular involvement in anterior myocardial infarction: a translational approach. Cardiovasc Res 2010; 87:601-8. [PMID: 20304784 DOI: 10.1093/cvr/cvq091] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of the present study was to evaluate the involvement of the right ventricle (RV) in reperfused anterior ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS Left anterior descending (LAD)-perfused area (using thioflavin-S staining after selective infusion in proximal LAD artery, %), infarct size (using triphenyltetrazolium chloride staining, %), and salvaged myocardium (% of LAD-perfused area) in the right and left ventricle (LV) were quantified in a 90-min LAD occlusion 3-day reperfusion model in swine (n = 8). Additionally, we studied, using cardiovascular magnetic resonance, 20 patients with a first STEMI due to proximal LAD occlusion treated with primary angioplasty. Area at risk (T2-weighted sequence, %), infarct size (late enhancement imaging, %), and salvaged myocardium (% of area at risk) in the right and LV were quantified. In swine, a large LAD-perfused area was detected both in the right and LV (30 +/- 5 vs. 62 +/- 15%, P< 0.001) but more salvaged myocardium (94 +/- 6 vs. 73 +/- 11%, P< 0.001) resulted in a smaller right ventricular infarct size (2 +/- 1 vs. 16 +/- 5%, P< 0.001). Similarly, in patients a large area at risk was detected both in the right and LV (34 +/- 13 vs. 43 +/- 12%, P = 0.02). More salvaged myocardium (94 +/- 10 vs. 33 +/- 26%, P < 0.001) resulted in a smaller infarct size (2 +/- 3 vs. 30 +/- 16%, P< 0.001) in the RV. CONCLUSION In reperfused extensive anterior STEMI, a large area of the RV is at risk but the resultant infarct size is small.
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Affiliation(s)
- Vicente Bodi
- Department of Cardiology, Hospital Clinico Universitario, INCLIVA, University of Valencia, Blasco Ibanez 17, Valencia 46010, Spain.
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Sanz J. Hacia la caracterización completa del infarto de miocardio con resonancia magnética. Rev Esp Cardiol (Engl Ed) 2009. [DOI: 10.1016/s0300-8932(09)72066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sanz J. Towards the complete characterization of myocardial infarcts by magnetic resonance imaging. Rev Esp Cardiol 2009; 62:847-850. [PMID: 19706239 DOI: 10.1016/s1885-5857(09)72648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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