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Atrial fibrillation is one of the most complex cardiac arrhythmias. The pathophysiological mechanisms of this process will probably include the following components: a complex interaction between the focal trigger activity in the area of the pulmonary veins, which is a trigger for arrhythmias and arrhythmogenic substrate contributes to its maintenance. Components of arrhythmogenic process, in its turn, connected to a structural remodelling of the myocardium, in particular with the formation of fibrosis. In recent years, in order to assess the degree of structural remodelling and volume of fibrous tissue changes in patients both before surgery and after, non-invasive imaging techniques are getting more and more widely used, such as cardiac magnetic resonance imaging. Processing and interpretation of data using cardiac magnetic resonance imaging is still an area for discussion. The aim of this article is to summarize data on atrial fibrosis and its evaluation using standard catheter techniques, new non-invasive imaging techniques as well as new approaches in the use of cardiac magnetic resonance imaging developed by our group in patients with atrial fibrillation.

Resumen Se analiza la utilidad de la ecocardiografía y nuevas técnicas de dianóstico cardiológico no invasivo en la valoración de la insuficiencia cardiaca. Se valora la utilidad de la coronariografía no invasiva por tomografía computarizada, así como las crecientes aplicaciones de la resonancia magnética en el estudio de la cardiopatía isquémica, miocardiopatías y displasia arritmogénica del ventrículo derecho. Para este propósito, se utilizan algunos casos clínicos. Se enfatiza la importancia del uso combinado de estas técnicas, especialmente en los pacientes con insuficiencia cardiaca cuya etiología sea la cardiopatía isquémica o alguna miocardiopatía.

Introduction and Objectives: The index of microcirculatory resistance (IMR) measured after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is associated with microvascular obstruction (MVO) and adverse clinical events. To evaluate MVO after successful primary PCI for STEMI without pressure wires or hyperemic agents, we investigated the feasibility and usefulness of functional angiography-derived IMR (angio-IMR)., Methods: The current study included a total of 285 STEMI patients who underwent primary PCI and cardiac magnetic resonance (CMR). Angio-IMR of the culprit vessel after successful primary PCI was calculated using commercial software. MVO, infarct size, and myocardial salvage index were assessed using CMR, which was obtained a median of 3.0 days [interquartile range, 3.0-5.0] after primary PCI., Results: Among the total population, 154 patients (54.0%) showed elevated angio-IMR (> 40 U) in the culprit vessel. MVO was significantly more prevalent in patients with angio-IMR> 40 U than in those with angio-IMR ≤ 40 U (88.3% vs 32.1%, P <.001). Infarct size, extent of MVO, and area at risk were significantly larger in patients with angio-IMR> 40 U than in those with angio-IMR ≤ 40 U (P <.001 for all). Angio-IMR showed a significantly higher discriminatory ability for the presence of MVO than thrombolysis in myocardial infarction flow grade or myocardial blush grade (area under the curve: 0.821, 0.504, and 0.496, respectively, P <.001)., Conclusions: Angio-IMR was significantly associated with CMR-derived infarct size, extent of MVO, and area at risk. An elevated angio-IMR (> 40 U) after primary PCI for STEMI was highly predictive of the presence of MVO in CMR. This trial was registered at ClnicalTrialsgov (Identifier: NCT04828681)., (Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Congenitally corrected transposition of the great vessels implies double discordance: atrioventricular and ventriculoarterial. We present cardiac magnetic resonance images from a 9-year-old girl with congenitally corrected transposition of the great vessels, interventricular communication, and coarctation of the aorta who was treated with pulmonary artery banding, correction of coarctation, and posterior double switch. We also review the disease and the complications that should be evaluated after the surgical intervention., (Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: We sought to determine the association of reciprocal change in the ST-segment with myocardial injury assessed by cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI)., Methods: We performed CMR imaging in 244 patients who underwent primary PCI for their first STEMI; CMR was performed a median 3 days after primary PCI. The first electrocardiogram was analyzed, and patients were stratified according to the presence of reciprocal change. The primary outcome was infarct size measured by CMR. Secondary outcomes were area at risk and myocardial salvage index., Results: Patients with reciprocal change (n=133, 54.5%) had a lower incidence of anterior infarction (27.8% vs 71.2%, P < .001) and shorter symptom onset to balloon time (221.5±169.8 vs 289.7±337.3min, P=.042). Using a multiple linear regression model, we found that patients with reciprocal change had a larger area at risk (P=.002) and a greater myocardial salvage index (P=.04) than patients without reciprocal change. Consequently, myocardial infarct size was not significantly different between the 2 groups (P=.14). The rate of major adverse cardiovascular events, including all-cause death, myocardial infarction, and repeat coronary revascularization, was similar between the 2 groups after 2 years of follow-up (P=.92)., Conclusions: Reciprocal ST-segment change was associated with larger extent of ischemic myocardium at risk and more myocardial salvage but not with final infarct size or adverse clinical outcomes in STEMI patients undergoing primary PCI., (Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease., Material and Methods: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease)., Results: We included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87)., Conclusions: Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability., (Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

The usefulness of echocardiography and the new noninvasive cardiac techniques in assessing heart failure is analyzed. The usefulness of non-invasive CT coronary angiography, as well as the growing applications of magnetic resonance imaging (MRI) in the study of ischemic heart disease, cardiomyopathy and arrhythmogenic right ventricular dysplasia is considered. For this puspose, some clinical cases are used. The combined use of these techniques, especially in patients in whom the etiology of heart failure is ischemic heart disease or cardiomyopathy is emphasized.

The development of myocardial fibrosis is a common process in the appearance of ventricular dysfunction in many heart diseases. Magnetic resonance imaging makes it possible to accurately evaluate the structure and function of the heart, and its role in the macroscopic characterization of myocardial fibrosis by late enhancement techniques has been widely validated clinically. Recent studies have demonstrated that T1-mapping techniques can quantify diffuse myocardial fibrosis and the expansion of the myocardial extracellular space in absolute terms. However, further studies are necessary to validate the usefulness of this technique in the early detection of tissue remodeling at a time when implementing early treatment would improve a patient's prognosis. This article reviews the state of the art for T1 mapping of the myocardium, its clinical applications, and its limitations., (Copyright © 2016 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Cardiac magnetic resonance imaging is considered the reference technique for characterizing myocardial tissue; for example, T2-weighted sequences make it possible to evaluate areas of edema or myocardial inflammation. However, traditional sequences have many limitations and provide only qualitative information. Moreover, traditional sequences depend on the reference to remote myocardium or skeletal muscle, which limits their ability to detect and quantify diffuse myocardial damage. Recently developed magnetic resonance myocardial mapping techniques enable quantitative assessment of parameters indicative of edema. These techniques have proven better than traditional sequences both in acute cardiomyopathy and in acute ischemic heart disease. This article synthesizes current developments in T2 mapping as well as their clinical applications and limitations., (Copyright © 2014 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Cardiac magnetic resonance imaging (cMRI) provides abundant morphological and functional information in the study of congenital heart disease. The functional information includes pulmonary output and systemic output; the ratio between these two (Qp/Qs) is the shunt fraction. After birth, in normal conditions the pulmonary output is practically identical to the systemic output, so Qp/Qs = 1. In patients with « shunts » between the systemic and pulmonary circulations, the ratio changes, and the interpretation of these findings varies in function of the location of the shunt (intracardiac or extracardiac) and of the associated structural or postsurgical changes. We review the concept of Qp/Qs; the methods to calculate it, with special emphasis on cMRI; and the meaning of the results obtained. We place special emphasis on the relevance of these findings depending on the underlying disease and the treatment the patient has undergone., (Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To compare the methods of right ventricle segmentation in the short-axis and 4-chamber planes in cardiac magnetic resonance imaging and to correlate the findings with those of the tricuspid annular plane systolic excursion (TAPSE) method in echocardiography., Material and Methods: We used a 1.5T MRI scanner to study 26 patients with diverse cardiovascular diseases. In all MRI studies, we obtained cine-mode images from the base to the apex in both the short-axis and 4-chamber planes using steady-state free precession sequences and 6mm thick slices. In all patients, we quantified the end-diastolic volume, end-systolic volume, and the ejection fraction of the right ventricle. On the same day as the cardiac magnetic resonance imaging study, 14 patients also underwent echocardiography with TAPSE calculation of right ventricular function., Results: No statistically significant differences were found in the volumes and function of the right ventricle calculated using the 2 segmentation methods. The correlation between the volume estimations by the two segmentation methods was excellent (r=0,95); the correlation for the ejection fraction was slightly lower (r=0,8). The correlation between the cardiac magnetic resonance imaging estimate of right ventricular ejection fraction and TAPSE was very low (r=0,2, P<.01)., Conclusion: Both ventricular segmentation methods quantify right ventricular function adequately. The correlation with the echocardiographic method is low., (Copyright © 2012 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)