68 results on '"Prat-González S"'
Search Results
2. Prevalence and pattern of cardiovascular magnetic resonance late gadolinium enhancement in highly trained endurance athletes
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Domenech-Ximenos, B., Sanz-de la Garza, M., Prat-González, S., Sepúlveda-Martínez, A., Crispi, F., Duran-Fernandez, K., Perea, R. J., Bijnens, B., and Sitges, M.
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- 2020
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Catalog
3. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document
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Barreiro-Pérez, M., primary, Cabeza, B., additional, Calvo, D., additional, Reyes-Juárez, J.L., additional, Datino, T., additional, Vañó Galván, E., additional, Maceira González, A.M., additional, Delgado Sánchez-Gracián, C., additional, Prat-González, S., additional, Perea, R.J., additional, Bastarrika, G., additional, Sánchez, M., additional, Jiménez-Borreguero, L.J., additional, Fernández-Golfín Lobán, C., additional, Rodríguez Palomares, J.F., additional, Tolosana, J.M., additional, Hidalgo Pérez, J.A., additional, Pérez-David, E., additional, Bertomeu-González, V., additional, and Cuéllar, H., additional more...
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- 2023
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4. Parametric techniques for characterizing myocardial tissue through magnetic resonance imaging (Part 1): T1 mapping
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Perea Palazón, R.J., Ortiz Pérez, J.T., Prat González, S., de Caralt Robira, T.M., Cibeira López, M.T., and Solé Arqués, M.
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- 2016
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5. Técnicas paramétricas de caracterización tisular del miocardio mediante resonancia magnética (parte 1): mapas de T1
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Perea Palazón, R.J., Ortiz Pérez, J.T., Prat González, S., de Caralt Robira, T.M., Cibeira López, M.T., and Solé Arqués, M.
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- 2016
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6. Parametric methods for characterizing myocardial tissue by magnetic resonance imaging (part 2): T2 mapping
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Perea Palazón, R.J., Solé Arqués, M., Prat González, S., de Caralt Robira, T.M., Cibeira López, M.T., and Ortiz Pérez, J.T.
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- 2015
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7. Técnicas paramétricas de caracterización tisular del miocardio mediante resonancia magnética (parte 2): mapas de T2
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Perea Palazón, R.J., Solé Arqués, M., Prat González, S., de Caralt Robira, T.M., Cibeira López, M.T., and Ortiz Pérez, J.T.
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- 2015
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8. Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT
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Barreiro-Pérez, M., primary, Cabeza, B., additional, Calvo, D., additional, Reyes-Juárez, J.L., additional, Datino, T., additional, Vañó Galván, E., additional, Maceira González, A.M., additional, Delgado Sánchez-Gracián, C., additional, Prat-González, S., additional, Perea, R.J., additional, Bastarrika, G., additional, Sánchez, M., additional, Jiménez-Borreguero, L.J., additional, Fernández-Golfín Lobán, C., additional, Rodríguez Palomares, J.F., additional, Tolosana, J.M., additional, Hidalgo Pérez, J.A., additional, Pérez-David, E., additional, Bertomeu-González, V., additional, and Cuéllar, H., additional more...
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- 2022
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9. Exercise Capacity in Young Adults Born Small for Gestational Age
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Fàtima Crispi Brillas, Rodriguez-Lopez RM, Bernardino G, Sepúlveda-Martínez Á, Prat-González S, Pajuelo C, Perea RJ, Caralt MT, Casu G, Vellvé K, Crovetto F, Burgos F, De Craene M, Butakoff C, González Ballester MÁ, Blanco I, Sitges M, Bijnens B, and Gratacós E more...
- Abstract
IMPORTANCE: Being born small for gestational age (SGA), approximately 10% of all births, is associated with increased risk of cardiovascular mortality in adulthood, but mechanistic pathways are unclear. Cardiac remodeling and dysfunction occur in fetuses SGA and children born SGA, but it is uncertain whether and how these changes persist into adulthood. OBJECTIVE: To evaluate baseline cardiac function and structure and exercise capacity in young adults born SGA. DESIGN, SETTING, AND PARTICIPANTS: This cohort study conducted from January 2015 to January 2018 assessed a perinatal cohort born at a tertiary university hospital in Spain between 1975 and 1995. Participants included 158 randomly selected young adults aged 20 to 40 years born SGA (birth weight below the 10th centile) or with intrauterine growth within standard reference ranges (controls). Participants provided their medical history, filled out questionnaires regarding smoking and physical activity habits, and underwent incremental cardiopulmonary exercise stress testing, cardiac magnetic resonance imaging, and a physical examination, with blood pressure, glucose level, and lipid profile data collected. EXPOSURE: Being born SGA. MAIN OUTCOMES AND MEASURES: Cardiac structure and function assessed by cardiac magnetic resonance imaging, including biventricular end-diastolic shape analysis. Exercise capacity assessed by incremental exercise stress testing. RESULTS: This cohort study included 81 adults born SGA (median age at study, 34.4 years [IQR, 30.8-36.7 years]; 43 women [53%]) and 77 control participants (median age at study, 33.7 years [interquartile range (IQR), 31.0-37.1 years]; 33 women [43%]). All participants were of White race/ethnicity and underwent imaging, whereas 127 participants (80% of the cohort; 66 control participants and 61 adults born SGA) completed the exercise test. Cardiac shape analysis showed minor changes at rest in right ventricular geometry (DeLong test z, 2.2098; P = .02) with preserved cardiac function in individuals born SGA. However, compared with controls, adults born SGA had lower exercise capacity, with decreased maximal workload (mean [SD], 180 [62] W vs 214 [60] W; P = .006) and oxygen consumption (median, 26.0 mL/min/kg [IQR, 21.5-33.5 mL/min/kg vs 29.5 mL/min/kg [IQR, 24.0-36.0 mL/min/kg]; P = .02). Exercise capacity was significantly correlated with left ventricular mass (? = 0.7934; P < .001). CONCLUSIONS AND RELEVANCE: This cohort of young adults born SGA had markedly reduced exercise capacity. These results support further research to clarify the causes of impaired exercise capacity and the potential association with increased cardiovascular mortality among adults born SGA. more...
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- 2021
10. Atrioventricular plane displacement versus mitral and tricuspid annular plane systolic excursion: A comparison between cardiac magnetic resonance and M-mode echocardiography
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Sepúlveda-Martínez A, Steding-Ehrenborg K, Rodriguez-Lopez RM, Ostenfeld E, Valenzuela-Alcaraz BI, Heiberg E, Gratacós E, Prat-González S, Fàtima Crispi Brillas, and Hedström E
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TAPSE ,comparison ,echocardiography ,atrioventricular plane displacement ,cardiac magnetic resonance ,MAPSE - Abstract
INTRODUCTION: Both echocardiography and CMR imaging are used to quantify longitudinal function. Inter-method variability for mitral (MAPSE) and tricuspid (TAPSE) annular plane systolic excursion, and variability between directly measured MAPSE and TAPSE and as based on atrioventricular plane displacement (AVPD) analysis by CMR, are, however, not known. This study, therefore, assessed inter-method variability and variability between annular plane systolic excursion and AVPD-based values in a healthy adult population. METHODS: Echocardiography and CMR were performed in 111 adults (35 [32-38] years). Method comparisons were assessed with Deming regression, Bland-Altman analysis and coefficient of variation. Observer reproducibility was assessed by the concordance correlation coefficient. RESULTS: Echocardiography and semi-automatic CMR agreed on MAPSE (17 ± 2 mm vs. 17 ± 2 mm, p = 0.1) and TAPSE (25 ± 3 mm vs. 25 ± 3 mm, p = 0.5), correlated highly between methods (fitted-slope 1.22 [95% CI 1.07-1.38] and 1.12 [95% CI 0.95-1.29]) and showed low bias (0.42 [95% CI - 2.05 to 2.88] and - 0.18 [95% CI - 4.78 to 4.43]). Intra-/inter-observer reproducibility was high for both methods for both MAPSE (echocardiography 0.96/0.86; CMR 0.87/0.85) and TAPSE (echocardiography 0.96/0.95; CMR 0.97/0.96). MAPSE (16 ± 2 mm vs. 17 ± 2 mm; p more...
- Published
- 2021
11. Patrón de flujo en '4D Flow' y su vínculo con la aortopatía bicúspide
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Vega, J, Lorenzatti, D, Ortiz-Pérez, JT, Perea, RJ, Doltra, A, Caralt, TM, Sotes, S, and Prat-González, S
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Wall shear stress ,cardiac MRI ,Vascular function ,Bicuspid Aortic Valve ,Aortic Aneurysm - Abstract
Bicuspid aortic valve (BAV) disease is generally associated with thoracic aortic dilatation (TAD). Related factors include; genetical, morphological (valvular phenotype) and most recently, hemodynamic profiles associated with flow pattern and wall shear stress. Cardiac magnetic resonance 4D Flow (4DF) can give an integral evaluation of these later flow variables. Remarkable, different spectrums of flow and vortex direction exist in BAV that are related to the site of TAD (proximal or distal). Therefore, we present a 57 years old patient with BAV (Sievers 0) with anteroposterior leaflets distribution in which 4DF depicted an anteriorly and righthand oriented jet that correlated with the zone of grater AD; also, vortex rotation was counterclockwise, corresponding to the most frequent vortex type in BAV. In conclusion, 4DF is a powerful and ground-breaking tool that enhances our knowledge of BAV related aortopathy. more...
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- 2019
12. Patrón de flujo en “4D Flow” y su vínculo con la aortopatía bicúspide
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Vega, J, primary, Lorenzatti, D, additional, Ortiz-Pérez, JT, additional, Perea, RJ, additional, Doltra, A, additional, Caralt, TM, additional, Sotes, S, additional, and Prat-González, S, additional
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- 2019
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13. Muerte súbita: estratificación del riesgo por RM cardíaca
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Domenech-Ximenos, B., Jiménez-Arjona, R., Ortiz-Pérez, J.T., Perea, R.J., Sánchez, M., Prat-González, S., and Doltra, A.
- Abstract
La muerte súbita cardíaca (MSC) puede estar causada por múltiples enfermedades cardíacas, que varían según la edad de los pacientes, y es reconocida como un problema de salud pública. La estratificación del riesgo de MSC es un tema controvertido que asocia un extenso debate a su alrededor, ya que es complicado decidir el momento adecuado para indicar la implementación de un desfibrilador automático implantable. Dado que los eventos arrítmicos se asocian con la presencia de cicatrices miocárdicas, en la estratificación de la MSC se debería ir más allá de la valoración de la función sistólica. En ello juega un papel fundamental la resonancia magnética cardíaca, ya que permite la caracterización no invasiva de la fibrosis miocárdica macroscópica e intersticial, así como de su patrón y su extensión. En este artículo se revisa el papel de la resonancia magnética cardíaca en la valoración y predicción del riesgo de MSC. more...
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- 2024
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14. Early metoprolol administration before coronary reperfusion results in increased myocardial salvage: analysis of ischemic myocardium at risk using cardiac magnetic resonance.
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Ibanez B, Prat-González S, Speidl WS, Vilahur G, Pinero A, Cimmino G, García MJ, Fuster V, Sanz J, and Badimon JJ
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- 2007
15. Stress cardiac magnetic resonance imaging in elderly patients
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Naïmi Alain, Magliano Yannick, Fassa Amir-Ali, Prat-Gonzalez Susanna, Ashrafpoor Golmehr, and Sztajzel Juan
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2011
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16. 155 Quantification of pulse wave velocity in the pulmonary artery in patients with pulmonary hypertension
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Fuster Valentin, Macaluso Frank, Prat-Gonzalez Susanna, Sanz Javier, and Garcia Mario
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2008
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17. 4D-flow CMR assessment: a key tool in corrected congenital heart diseases.
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Morr-Verenzuela CI, Fuentes Latorre E, and Prat-González S
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- Humans, Magnetic Resonance Imaging, Cine, Predictive Value of Tests, Magnetic Resonance Imaging, Reproducibility of Results, Heart Defects, Congenital diagnostic imaging
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- 2024
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18. Association of central obesity with unique cardiac remodelling in young adults born small for gestational age.
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Bernardino G, Sepúlveda-Martínez Á, Rodríguez-López M, Prat-González S, Pajuelo C, Perea RJ, Caralt MT, Crovetto F, González Ballester MA, Sitges M, Bijnens B, and Crispi F
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- Infant, Newborn, Pregnancy, Female, Humans, Young Adult, Birth Weight, Gestational Age, Infant, Small for Gestational Age, Obesity, Obesity, Abdominal diagnostic imaging, Obesity, Abdominal epidemiology, Ventricular Remodeling
- Abstract
Aims: Being born small for gestational age (SGA, 10% of all births) is associated with increased risk of cardiovascular mortality in adulthood together with lower exercise tolerance, but mechanistic pathways are unclear. Central obesity is known to worsen cardiovascular outcomes, but it is uncertain how it affects the heart in adults born SGA. We aimed to assess whether central obesity makes young adults born SGA more susceptible to cardiac remodelling and dysfunction., Methods and Results: A perinatal cohort from a tertiary university hospital in Spain of young adults (30-40 years) randomly selected, 80 born SGA (birth weight below 10th centile) and 75 with normal birth weight (controls) was recruited. We studied the associations between SGA and central obesity (measured via the hip-to-waist ratio and used as a continuous variable) and cardiac regional structure and function, assessed by cardiac magnetic resonance using statistical shape analysis. Both SGA and waist-to-hip were highly associated to cardiac shape (F = 3.94, P < 0.001; F = 5.18, P < 0.001 respectively) with a statistically significant interaction (F = 2.29, P = 0.02). While controls tend to increase left ventricular end-diastolic volumes, mass and stroke volume with increasing waist-to-hip ratio, young adults born SGA showed a unique response with inability to increase cardiac dimensions or mass resulting in reduced stroke volume and exercise capacity., Conclusion: SGA young adults show a unique cardiac adaptation to central obesity. These results support considering SGA as a risk factor that may benefit from preventive strategies to reduce cardiometabolic risk., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.) more...
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- 2023
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19. Quantification of right atrial fibrosis by cardiac magnetic resonance: verification of the method to standardize thresholds.
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Gunturiz-Beltrán C, Borràs R, Alarcón F, Garre P, Figueras I Ventura RM, Benito EM, Caixal G, Althoff TF, Tolosana JM, Arbelo E, Roca-Luque I, Prat-González S, Perea RJ, Brugada J, Sitges M, Guasch E, and Mont L more...
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- Humans, Cicatrix pathology, Cicatrix surgery, Contrast Media, Heart Atria pathology, Magnetic Resonance Imaging methods, Fibrosis, Gadolinium, Magnetic Resonance Spectroscopy, Atrial Fibrillation surgery, Catheter Ablation methods
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Introduction and Objectives: Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) allows noninvasive detection of left atrial fibrosis in patients with atrial fibrillation (AF). However, whether the same methodology can be used in the right atrium (RA) remains unknown. Our aim was to define a standardized threshold to characterize RA fibrosis in LGE-CMR., Methods: A 3 Tesla LGE-CMR was performed in 53 individuals; the RA was segmented, and the image intensity ratio (IIR) calculated for the RA wall using 1 557 767 IIR pixels (40 994±10 693 per patient). The upper limit of normality of the IIR (mean IIR+2 standard deviations) was estimated in healthy volunteers (n=9), and patients who had undergone previous typical atrial flutter ablation (n=9) were used to establish the dense scar threshold. Paroxysmal and persistent AF patients (n=10 each) were used for validation. IIR values were correlated with a high-density bipolar voltage map in 15 patients undergoing AF ablation., Results: The upper normality limit (total fibrosis threshold) in healthy volunteers was set at an IIR = 1.21. In the postablation group, 60% of the maximum IIR pixel (dense fibrosis threshold) was calculated as IIR = 1.29. Endocardial bipolar voltage showed a weak but significant correlation with IIR. The overall accuracy between the electroanatomical map and LGE-CMR to characterize fibrosis was 56%., Conclusions: An IIR > 1.21 was determined to be the threshold for the detection of right atrial fibrosis, while an IIR > 1.29 differentiates interstitial fibrosis from dense scar. Despite differences between the left and right atria, fibrosis could be assessed with LGE-CMR using similar thresholds in both chambers., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.) more...
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- 2023
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20. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, and Cuéllar H more...
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- Humans, Consensus, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Heart Diseases, Cardiology, Defibrillators, Implantable
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Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool., (Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.) more...
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- 2023
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21. Sex as a main determinant of bi-atrial acute and chronic adaptation to exercise.
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Simard F, Sanz-de la Garza M, Vaquer-Seguí A, Blanco I, Burgos F, Alsina X, Prat-González S, and Sitges M
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- Male, Humans, Female, Echocardiography, Exercise, Athletes, Heart Atria diagnostic imaging, Atrial Function physiology
- Abstract
Purpose: Athlete's heart encompasses multiple physiological cardiac adaptations, although less is known at atrial level. How sex may influence the type and extent of atrial adaptations to exercise stimuli is also unknown. Our objective was to compare gender differences of echocardiographic atrial function indices in response to exercise in endurance athletes (EAs)., Methods: Highly trained (> 10 h/week) endurance athletes performed a maximal cardiopulmonary exercise test (CPET). Echocardiographic evaluation was performed at rest and immediately after exercise. Atria analysis consisted of standard and speckle-tracking echocardiographic assessment of atrial dimensions and contractile, reservoir, and conduit functions with myocardial deformation., Results: 80 EAs (55% women) were enrolled and performed excellent CPET (129.6% of predicted VO
2 maximal consumption). At rest, left atrial (LA) volumes and strain were similar between men and women. Women had lower right atrial (RA) volumes (26.7 vs 32.9 ml/m2 , p < 0.001) and higher reservoir and conduit strain absolute values. After exercise, women exhibited a larger improvement in reservoir and conduit LA strain, and the same trend was observed for the RA. In EAs with LA dilatation on baseline (~ 50%), women persistently showed higher increase in reservoir and conduit strain profile with exercise compared to men., Conclusion: In highly trained EAs, women have similar or even lower atrial dimensions remodelling compared to men, but better function based on reservoir and conduit strain values both at rest and in response to exercise. This phenomenon should be confirmed in larger studies and its potential role in the development of supraventricular arrhythmias, addressed in a specifically designed protocol., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) more...- Published
- 2022
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22. Progressive and Simultaneous Right and Left Atrial Remodeling Uncovered by a Comprehensive Magnetic Resonance Assessment in Atrial Fibrillation.
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Gunturiz-Beltrán C, Nuñez-Garcia M, Althoff TF, Borràs R, Figueras I Ventura RM, Garre P, Caixal G, Prat-González S, Perea RJ, Benito EM, Tolosana JM, Arbelo E, Roca-Luque I, Brugada J, Sitges M, Mont L, and Guasch E more...
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- Humans, Gadolinium, Heart Atria, Fibrosis, Magnetic Resonance Spectroscopy, Atrial Remodeling, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Atrial Fibrillation pathology, Catheter Ablation methods
- Abstract
Background Left atrial structural remodeling contributes to the arrhythmogenic substrate of atrial fibrillation (AF), but the role of the right atrium (RA) remains unknown. Our aims were to comprehensively characterize right atrial structural remodeling in AF and identify right atrial parameters predicting recurrences after ablation. Methods and Results A 3.0 T late gadolinium enhanced-cardiac magnetic resonance was obtained in 109 individuals (9 healthy volunteers, 100 patients with AF undergoing ablation). Right and left atrial volume, surface, and sphericity were quantified. Right atrial global and regional fibrosis burden was assessed with validated thresholds. Patients with AF were systematically followed after ablation for recurrences. Progressive right atrial dilation and an increase in sphericity were observed from healthy volunteers to patients with paroxysmal and persistent AF; fibrosis was similar among the groups. The correlation between parameters recapitulating right atrial remodeling was mild. Subsequently, remodeling in both atria was compared. The RA was larger than the left atrium (LA) in all groups. Fibrosis burden was higher in the LA than in the RA of patients with AF, whereas sphericity was higher in the LA of patients with persistent AF only. Fibrosis, volume, and surface of the RA and LA, but not sphericity, were strongly correlated. Tricuspid regurgitation predicted right atrial volume and shape, whereas diabetes was associated with right atrial fibrosis burden; sex and persistent AF also predicted right atrial volume. Fibrosis in the RA was mostly located in the inferior vena cava-RA junction. Only right atrial sphericity is significantly associated with AF recurrences after ablation (hazard ratio, 1.12 [95% CI, 1.01-1.25]). Conclusions AF progression associates with right atrial remodeling in parallel with the LA. Right atrial sphericity yields prognostic significance after ablation. more...
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- 2022
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23. Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction.
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Jáuregui B, Soto-Iglesias D, Penela D, Acosta J, Fernández-Armenta J, Linhart M, Ordóñez A, San Antonio R, Terés C, Chauca A, Carreño JM, Scherer C, Falasconi G, Prat-González S, Perea RJ, Mont L, Bosch X, Ortiz-Pérez JT, and Berruezo A more...
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- Arrhythmias, Cardiac complications, Arrhythmias, Cardiac etiology, Case-Control Studies, Cicatrix, Contrast Media, Gadolinium, Humans, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Retrospective Studies, Stroke Volume, Ventricular Function, Left, Myocardial Infarction complications, Myocardial Infarction diagnostic imaging, Myocardial Infarction pathology, Tachycardia, Ventricular diagnostic imaging, Tachycardia, Ventricular etiology
- Abstract
Aims: To non-invasively characterize, by means of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR), scar differences, and potential variables associated with ventricular tachycardia (VT) occurrence in chronic post-myocardial infarction (MI) patients., Methods and Results: A case-control study was designed through retrospective LGE-CMR data analysis of chronic post-MI patients (i) consecutively referred for VT substrate ablation after a first VT episode (n = 66) and (ii) from a control group (n = 84) with no arrhythmia evidence. The myocardium was characterized differentiating core, border zone (BZ), and BZ channels (BZCs) using the ADAS 3D post-processing imaging platform. Clinical and scar characteristics, including a novel parameter, the BZC mass, were compared between both groups. One hundred and fifty post-MI patients were included. Four multivariable Cox proportional hazards regression models were created for total scar mass, BZ mass, core mass, and BZC mass, adjusting them by age, sex, and left ventricular ejection fraction (LVEF). A cut-off of 5.15 g of BZC mass identified the cases with 92.4% sensitivity and 86.9% specificity [area under the ROC curve (AUC) 0.93 (0.89-0.97); P < 0.001], with a significant increase in the AUC compared to other scar parameters (P < 0.001 for all pairwise comparisons). Adding BZC mass to LVEF allowed to reclassify 33.3% of the cases and 39.3% of the controls [net reclassification improvement = 0.73 (0.71-0.74)]., Conclusions: The mass of BZC is the strongest independent variable associated with the occurrence of sustained monomorphic ventricular tachycardia in post-MI patients after adjustment for age, sex, and LVEF. Border zone channel mass measurement could permit a more accurate VT risk stratification than LVEF in chronic post-MI patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.) more...
- Published
- 2022
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24. Exercise Capacity in Young Adults Born Small for Gestational Age.
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Crispi F, Rodríguez-López M, Bernardino G, Sepúlveda-Martínez Á, Prat-González S, Pajuelo C, Perea RJ, Caralt MT, Casu G, Vellvé K, Crovetto F, Burgos F, De Craene M, Butakoff C, González Ballester MÁ, Blanco I, Sitges M, Bijnens B, and Gratacós E more...
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- Adult, Cardiovascular Diseases epidemiology, Female, Gestational Age, Humans, Incidence, Male, Spain epidemiology, Young Adult, Cardiovascular Diseases physiopathology, Exercise physiology, Exercise Tolerance physiology, Infant, Small for Gestational Age physiology
- Abstract
Importance: Being born small for gestational age (SGA), approximately 10% of all births, is associated with increased risk of cardiovascular mortality in adulthood, but mechanistic pathways are unclear. Cardiac remodeling and dysfunction occur in fetuses SGA and children born SGA, but it is uncertain whether and how these changes persist into adulthood., Objective: To evaluate baseline cardiac function and structure and exercise capacity in young adults born SGA., Design, Setting, and Participants: This cohort study conducted from January 2015 to January 2018 assessed a perinatal cohort born at a tertiary university hospital in Spain between 1975 and 1995. Participants included 158 randomly selected young adults aged 20 to 40 years born SGA (birth weight below the 10th centile) or with intrauterine growth within standard reference ranges (controls). Participants provided their medical history, filled out questionnaires regarding smoking and physical activity habits, and underwent incremental cardiopulmonary exercise stress testing, cardiac magnetic resonance imaging, and a physical examination, with blood pressure, glucose level, and lipid profile data collected., Exposure: Being born SGA., Main Outcomes and Measures: Cardiac structure and function assessed by cardiac magnetic resonance imaging, including biventricular end-diastolic shape analysis. Exercise capacity assessed by incremental exercise stress testing., Results: This cohort study included 81 adults born SGA (median age at study, 34.4 years [IQR, 30.8-36.7 years]; 43 women [53%]) and 77 control participants (median age at study, 33.7 years [interquartile range (IQR), 31.0-37.1 years]; 33 women [43%]). All participants were of White race/ethnicity and underwent imaging, whereas 127 participants (80% of the cohort; 66 control participants and 61 adults born SGA) completed the exercise test. Cardiac shape analysis showed minor changes at rest in right ventricular geometry (DeLong test z, 2.2098; P = .02) with preserved cardiac function in individuals born SGA. However, compared with controls, adults born SGA had lower exercise capacity, with decreased maximal workload (mean [SD], 180 [62] W vs 214 [60] W; P = .006) and oxygen consumption (median, 26.0 mL/min/kg [IQR, 21.5-33.5 mL/min/kg vs 29.5 mL/min/kg [IQR, 24.0-36.0 mL/min/kg]; P = .02). Exercise capacity was significantly correlated with left ventricular mass (ρ = 0.7934; P < .001)., Conclusions and Relevance: This cohort of young adults born SGA had markedly reduced exercise capacity. These results support further research to clarify the causes of impaired exercise capacity and the potential association with increased cardiovascular mortality among adults born SGA. more...
- Published
- 2021
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25. Proximity to the descending aorta predicts regional fibrosis in the adjacent left atrial wall: aetiopathogenic and prognostic implications.
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Caixal G, Althoff T, Garre P, Alarcón F, NuñezGarcia M, Benito EM, Borras R, Perea RJ, Prat-González S, Gunturiz C, Sanchez P, Olivas D, Tolosana JM, Arbelo E, Roca-Luque I, Brugada J, Sitges M, Guasch E, and Mont L more...
- Subjects
- Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Contrast Media, Fibrosis, Gadolinium, Heart Atria diagnostic imaging, Heart Atria pathology, Heart Atria surgery, Humans, Magnetic Resonance Imaging, Prognosis, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation pathology, Catheter Ablation
- Abstract
Aims: Left atrial (LA) fibrosis is present in patients with atrial fibrillation (AF) and can be visualized by magnetic resonance imaging with late gadolinium enhancement (LGE-MRI). Previous studies have shown that LA fibrosis is not randomly distributed, being more frequent in the area adjacent to the descending aorta (DAo). The objective of this study is to analyse the relationship between fibrosis in the atrial area adjacent to the DAo and the distance to it, as well as the prognostic implications of this fibrosis., Methods and Results: Magnetic resonance imaging with late gadolinium enhancement was obtained in 108 patients before AF ablation to analyse the extent of LA fibrosis and the distance DAo-to-LA. A high-density electroanatomic map was performed in a subgroup of 16 patients to exclude the possibility of an MRI artifact. Recurrences after ablation were analysed at 1 year of follow-up. The extent of atrial fibrosis in the area adjacent to the DAo was inversely correlated with the distance DAo-to-LA (r = -0.34, P < 0.001). This area had the greatest intensity of LGE [image intensity ratio (IIR) 1.14 ± 0.15 vs. 0.99 ± 0.16; P < 0.001] and also the lowest voltage (1.07 ± 0.86 vs. 1.54 ± 1.07 mV; P < 0.001) and conduction velocity (0.65 ± 0.06 vs. 0.96 ± 0.57 mm/ms; P < 0.001). The extent of this regional fibrosis predicted recurrence after AF ablation [hazard ratio (HR) 1.02, 95% CI 1.01-1.03; P = 0.01], however total fibrosis did not (HR = 1.01, 95% CI 0.97-1.06, P = 0.54)., Conclusions: Atrial fibrosis was predominantly located in the area adjacent to the DAo, and increased with the proximity between the two structures. Furthermore, this regional fibrosis better predicted recurrence after AF ablation than total atrial fibrosis., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.) more...
- Published
- 2021
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26. Cardiac and Pulmonary Vascular Remodeling in Endurance Open Water Swimmers Assessed by Cardiac Magnetic Resonance: Impact of Sex and Sport Discipline.
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Martínez V, Sanz-de la Garza M, Domenech-Ximenos B, Fernández C, García-Alvarez A, Prat-González S, Yanguas C, and Sitges M
- Abstract
Background: The cardiac response to endurance exercise has been studied previously, and recent reports have described the extension of this remodeling to the pulmonary vasculature. However, these reports have focused primarily on land-based sports and few data are available on exercise-induced cardio-pulmonary adaptation in swimming. Nor has the impact of sex on this exercise-induced cardio-pulmonary remodeling been studied in depth. The main aim of our study was to evaluate cardiac and pulmonary circulation remodeling in endurance swimmers. Among the secondary objectives, we evaluate the impact of sex and endurance sport discipline on this cardio-pulmonary remodeling promoted by exercise training. Methods: Resting cardiovascular magnetic resonance imaging was performed in 30 healthy well-trained endurance swimmers (83.3% male) and in 19 terrestrial endurance athletes (79% male) to assess biventricular dimensions and function. Pulmonary artery dimensions and flow as well as estimates of pulmonary vascular resistance (PVR) were also evaluated. Results: In relation to the reference parameters for the non-athletic population, male endurance swimmers had larger biventricular and pulmonary artery size (7.4 ± 1.0 vs. 5.9 ± 1.1 cm
2 , p < 0.001) with lower biventricular ejection fraction (EF) (left ventricular (LV) EF: 58 ± 4.4 vs. 67 ± 4.5 %, p < 0.001; right ventricular (RV) EF: 60 ± 4 vs. 66 ± 6 %, p < 0.001), LV end-diastolic volume (EDV): 106 ± 11 vs. 80 ± 9 ml/m2 , p < 0.001; RV EDV: 101 ± 14 vs. 83 ± 12 ml/m2 , p < 0.001). Significantly larger LV volume and lower LV EF were also observed in female swimmers (LV EF: 60 ± 5.3 vs. 67 ± 4.6 %, p = 0.003; LV EDV: 90 ± 17.6 vs. 75± 8.7 ml/m2 , p = 0.002). Compared to terrestrial endurance athletes, swimmers showed increased LV indexed mass (75.0 ± 12.8 vs. 61.5 ± 10.0 g/m2 , p < 0.001). The two groups of endurance athletes had similar pulmonary artery remodeling. Conclusions: Cardiac response to endurance swimming training implies an adaptation of both ventricular and pulmonary vasculature, as in the case of terrestrial endurance athletes. Cardio-pulmonary remodeling seems to be less extensive in female than in male swimmers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Martínez, Sanz-de la Garza, Domenech-Ximenos, Fernández, García-Alvarez, Prat-González, Yanguas and Sitges.) more...- Published
- 2021
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27. Outcomes of Septal Myectomy beyond 65 Years, with and without Concomitant Procedures.
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Pruna-Guillen R, Pereda D, Castellà M, Sandoval E, Affronti A, García-Álvarez A, Perdomo J, Ibáñez C, Jordà P, Prat-González S, Alcocer J, Barriuso C, Llopis J, and Quintana E
- Abstract
Introduction and Objectives: Septal myectomy remains the first septal reduction therapy for hypertrophic obstructive cardiomyopathy in young patients and those requiring concomitant procedures. Its role in advanced ages is questioned due to perceived increased risk. We assess the outcomes of surgical relief of obstruction in patients beyond 65 years old., Methods: A single-center retrospective review of patients ≥ 65 years old undergoing septal myectomy through median sternotomy between April 2015 and February 2020., Results: We identified 52 patients. Mean age was 71.8 ± 4.9 years; 36 (69.2%) were females. All were symptomatic. Mean highest LVOT gradient was 90 ± 39 mmHg. All patients had systolic anterior motion (SAM) of the mitral valve and 36 (69.2%) ≥ moderate mitral regurgitation. Additional LVOT interventions beyond myectomy were performed in 34 (65.4%). At least one other cardiac concomitant procedure was performed 44 (84.6%). No perioperative mortality in elective surgery occurred. One patient (1.9%) developed atrio-ventricular block. Postoperative mean gradient was 4.3 ± 1.9 mmHg, with 46 (88.4%) achieving complete resolution of obstruction. Mitral regurgitation was reduced to grade ≤ I in 46 (88.5%). Mean follow-up time was 2.3 ± 1.2 years and 82% of patients were in NYHA I. Survival at 2 years was 98%., Conclusion: Septal myectomy in the elderly is a safe and effective operation despite the need for concomitant procedures. LVOT interventions beyond septal myectomy to relieve obstruction are common in this advanced cohort of hypertrophic cardiomyopathy patients. This operation carried at experienced centers seems an unmatched therapeutic option. more...
- Published
- 2021
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28. Accuracy of left atrial fibrosis detection with cardiac magnetic resonance: correlation of late gadolinium enhancement with endocardial voltage and conduction velocity.
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Caixal G, Alarcón F, Althoff TF, Nuñez-Garcia M, Benito EM, Borràs R, Perea RJ, Prat-González S, Garre P, Soto-Iglesias D, Gunturitz C, Cozzari J, Linhart M, Tolosana JM, Arbelo E, Roca-Luque I, Sitges M, Guasch E, and Mont L more...
- Subjects
- Contrast Media, Fibrosis, Gadolinium, Heart Atria surgery, Humans, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Atrial Fibrillation surgery, Catheter Ablation
- Abstract
Aims: Myocardial fibrosis is a hallmark of atrial fibrillation (AF) and its characterization could be used to guide ablation procedures. Late gadolinium enhanced-magnetic resonance imaging (LGE-MRI) detects areas of atrial fibrosis. However, its accuracy remains controversial. We aimed to analyse the accuracy of LGE-MRI to identify left atrial (LA) arrhythmogenic substrate by analysing voltage and conduction velocity at the areas of LGE., Methods and Results: Late gadolinium enhanced-magnetic resonance imaging was performed before ablation in 16 patients. Atrial wall intensity was normalized to blood pool and classified as healthy, interstitial fibrosis, and dense scar tissue depending of the resulting image intensity ratio. Bipolar voltage and local conduction velocity were measured in LA with high-density electroanatomic maps recorded in sinus rhythm and subsequently projected into the LGE-MRI. A semi-automatic, point-by-point correlation was made between LGE-MRI and electroanatomical mapping. Mean bipolar voltage and local velocity progressively decreased from healthy to interstitial fibrosis to scar. There was a significant negative correlation between LGE with voltage (r = -0.39, P < 0.001) and conduction velocity (r = -0.25, P < 0.001). In patients showing dilated atria (LA diameter ≥45 mm) the conduction velocity predictive capacity of LGE-MRI was weaker (r = -0.40 ± 0.09 vs. -0.20 ± 0.13, P = 0.02)., Conclusions: Areas with higher LGE show lower voltage and slower conduction in sinus rhythm. The enhancement intensity correlates with bipolar voltage and conduction velocity in a point-by-point analysis. The performance of LGE-MRI in assessing local velocity might be reduced in patients with dilated atria (LA diameter ≥45)., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.) more...
- Published
- 2021
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29. Arrhythmogenic substrate detection in chronic ischaemic patients undergoing ventricular tachycardia ablation using multidetector cardiac computed tomography: compared evaluation with cardiac magnetic resonance.
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Jáuregui B, Soto-Iglesias D, Zucchelli G, Penela D, Ordóñez A, Terés C, Chauca A, Acosta J, Fernández-Armenta J, Linhart M, Perea RJ, Prat-González S, Bosch X, Ortiz-Pérez JT, Mont L, and Berruezo A
- Subjects
- Aged, Gadolinium, Humans, Magnetic Resonance Imaging, Magnetic Resonance Imaging, Cine, Magnetic Resonance Spectroscopy, Male, Middle Aged, Multidetector Computed Tomography, Stroke Volume, Ventricular Function, Left, Contrast Media, Tachycardia, Ventricular diagnostic imaging, Tachycardia, Ventricular surgery
- Abstract
Aims: Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits characterizing ischaemic scars, detecting heterogeneous tissue channels (HTCs) which constitute the arrhythmogenic substrate (AS). Late gadolinium enhancement cardiac magnetic resonance also improves the arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation. However, its availability may be limited. We sought to evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying HTCs detected by LGE-CMR in ischaemic patients undergoing VT substrate ablation., Methods and Results: Thirty ischaemic patients undergoing both LGE-CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to LGE-CMR or MDCT analysis, characterized the presence of CMR and computed tomography (CT) channels, respectively. Cardiac magnetic resonance channels were classified as endocardial (layers < 50%), epicardial (layers ≥ 50%), or transmural. Cardiac magnetic resonance- vs. CT-channel concordance was considered when showing the same orientation and American Heart Association (AHA) segment. Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction was 35 ± 10%. All patients had CMR channels (n = 76), whereas only 26/30 (86.7%) had CT channels (n = 91). Global sensitivity (Se) and positive predictive values for detecting CMR channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR channels (Se 80.5%) and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial myocardial infarction (MI), MDCT was unable to identify the AS., Conclusions: Compared to LGE-CMR, myocardial wall thickness assessment using MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI, showing modest sensitivity identifying HTCs but a better performance in patients with transmural scars., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.) more...
- Published
- 2021
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30. Monocyte Subsets Are Differently Associated with Infarct Size, Left Ventricular Function, and the Formation of a Potentially Arrhythmogenic Scar in Patients with Acute Myocardial Infarction.
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Bosch X, Jáuregui B, Villamor N, Morales-Ruiz M, Ortiz-Pérez JT, Borràs R, Penela D, Soto-Iglesias D, Perea RJ, Doltra A, Prat-González S, Jiménez W, Mira Á, Lasalvia L, and Berruezo A
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- Aged, Arrhythmias, Cardiac immunology, Arrhythmias, Cardiac physiopathology, Biomarkers blood, Female, GPI-Linked Proteins blood, Humans, Lipopolysaccharide Receptors blood, Magnetic Resonance Imaging, Male, Middle Aged, Monocytes classification, Percutaneous Coronary Intervention, Prospective Studies, Receptors, IgG blood, Risk Factors, ST Elevation Myocardial Infarction immunology, ST Elevation Myocardial Infarction physiopathology, ST Elevation Myocardial Infarction therapy, Time Factors, Treatment Outcome, Arrhythmias, Cardiac etiology, Monocytes immunology, Myocardium pathology, ST Elevation Myocardial Infarction complications, Stroke Volume, Ventricular Function, Left, Ventricular Remodeling
- Abstract
To investigate the role of classical (CLM, CD14
++ CD16- ), intermediate (INTM, CD14++ CD16+ript> ), and non-classical (Non-CLM, CD14 + CD16++ ) monocytes in scar formation after ST-elevation myocardial infarction (STEMI), evaluated with cardiac magnetic resonance (CMR). One hundred two patients with a first STEMI had serial blood analyses after 1, 3, and 7 days. A CMR was performed at 7 days and 6 months, depicting scar core (CO), border zone (BZ), and the presence of BZ channels. CLM and INTM levels progressively decreased, correlated with the scar mass, CO, and BZ at 7 days and 6 months (p < 0.05), and inversely with left ventricular ejection fraction (LVEF, p < 0.01). Non-CLM levels gradually increased, correlated with BZ mass and the presence of BZ channels at 7 days and 6 months (p < 0.001).CLM and INTM are associated with infarct size and inversely with LVEF, whereas Non-CLM are associated with BZ mass and the presence of potentially arrhythmogenic substrate. more...- Published
- 2020
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31. Pulmonary transit of contrast during exercise is related to improved cardio-pulmonary performance in highly trained endurance athletes.
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Sanz-de la Garza M, Vaquer-Seguí A, Durán K, Blanco I, Burgos F, Alsina X, Prat-González S, Bijnens B, and Sitges M
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- Adult, Exercise Test, Female, Humans, Male, Middle Aged, Young Adult, Adaptation, Physiological, Athletes, Exercise Tolerance physiology, Lung physiology, Myocardial Contraction physiology, Ventricular Function, Left physiology, Ventricular Function, Right physiology
- Abstract
Background: The mechanisms underlying the high interindividual variability demonstrated for right-ventricular (RV) adaptation to exercise have not yet been identified, but different pulmonary vascular adaptations among individuals could be involved. Pulmonary transit of agitated saline (PTAS) during exercise has been demonstrated to be a good estimator of vascular reserve., Aim: The aim of this study was to evaluate the presence of PTAS among endurance athletes (EAs) of both sexes and its influence on RV adaptation to exercise., Methods: A total of 100 highly trained EAs performed a maximal cardiopulmonary exercise test. Bi-ventricular functional and structural characteristics as well as PTAS were evaluated at baseline and at peak exercise. Athletes were distributed between two groups based on the amount of PTAS during exercise as high (HTPAS; >12 bubbles) and low (LPTAS; ≤12 bubbles)., Results: Overall, 11 EAs exhibited an intra-cardiac shunt at rest and 1 met the criteria for chronic pulmonary disease and were excluded from the study. Among the remaining 88 EAs (51% women), 47 (53%) athletes were classified as HPTAS and 41 (47%) as LPTAS. HPTAS capability was associated with significantly larger RV contractile reserve, larger pulmonary vascular reserve and an enhanced maximal exercise capacity. On multivariate analysis, females were the only independent correlate of the HPTAS capability., Conclusion: In highly trained endurance athletes, a HPTAS capability during exercise corresponded to an increase in pulmonary vascular and RV contractile reserves as well as an enhanced maximal exercise capacity. The long-term clinical or performance implications of the absence or presence of pulmonary shunting, and the subsequent RV afterload increase while performing exercise, remains to be determined. more...
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- 2020
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32. Exercise-induced cardio-pulmonary remodelling in endurance athletes: Not only the heart adapts.
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Domenech-Ximenos B, Garza MS, Prat-González S, Sepúlveda-Martínez Á, Crispi F, Perea RJ, Garcia-Alvarez A, and Sitges M
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- Adaptation, Physiological, Adult, Arterial Pressure, Blood Flow Velocity, Case-Control Studies, Female, Humans, Male, Time Factors, Ventricular Function, Left, Athletes, Cardiomegaly, Exercise-Induced, Physical Conditioning, Human, Physical Endurance, Pulmonary Circulation, Vascular Remodeling, Ventricular Function, Right, Ventricular Remodeling
- Abstract
Background: The cumulative effects of intensive endurance exercise may induce a broad spectrum of right ventricular remodelling. The mechanisms underlying these variable responses have been scarcely explored, but may involve differential pulmonary vasculature adaptation. Our aim was to evaluate right ventricular and pulmonary circulation in highly trained endurance athletes., Methods: Ninety-three highly trained endurance athletes (>12 h training/week at least during the last five years; age: 36 ± 6 years; 52.7% male) and 72 age- and gender-matched controls underwent resting cardiovascular magnetic resonance imaging to assess cardiac dimensions and function, as well as pulmonary artery dimensions and flow. Pulmonary vascular resistance (PVR) was estimated based on left ventricular ejection fraction and pulmonary artery flow mean velocity. Resting and exercise Doppler echocardiography was also performed in athletes to estimate pulmonary artery pressure., Results: Athletes showed larger biventricular and biatrial sizes, slightly reduced systolic biventricular function, increased pulmonary artery dimensions and reduced pulmonary artery flow velocity as compared with controls in both genders ( p < 0.05), which resulted in significantly higher estimated PVR in athletes as compared with controls (2.4 ± 1.2 vs . 1.7 ± 1.1; p < 0.05). Substantially high estimated PVR values (>4.2 WU) were found in seven of the 93 (9.3%) athletes: those exhibiting an enlarged pulmonary artery (indexed area cm
2 /m2 : 4.8 ± 0.6 vs . 3.9 ± 0.6, p < 0.05), a decreased pulmonary artery distensibility index (%: 43.0 ± 15.2 vs . 62.0 ± 17.4, p < 0.05) and a reduced right ventricular ejection fraction (%: 49.3 ± 4.5 vs . 53.6 ± 4.6, p < 0.05)., Conclusions: Exercise-induced remodelling involves, besides the cardiac chambers, the pulmonary circulation and is associated with an increased estimated PVR. A small subset of athletes exhibited substantial increase of estimated PVR related to pronounced pulmonary circulation remodelling and reduced right ventricular systolic function. more...- Published
- 2020
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33. Cardiac Magnetic Resonance-Guided Ventricular Tachycardia Substrate Ablation.
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Soto-Iglesias D, Penela D, Jáuregui B, Acosta J, Fernández-Armenta J, Linhart M, Zucchelli G, Syrovnev V, Zaraket F, Terés C, Perea RJ, Prat-González S, Doltra A, Ortiz-Pérez JT, Bosch X, Camara O, and Berruezo A more...
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- Contrast Media, Gadolinium, Humans, Magnetic Resonance Spectroscopy, Catheter Ablation, Tachycardia, Ventricular diagnostic imaging, Tachycardia, Ventricular surgery
- Abstract
Objectives: This study assessed the feasibility and potential benefit of performing ventricular tachycardia (VT) substrate ablation procedures guided by cardiac magnetic resonance (CMR)-derived pixel signal intensity (PSI) maps., Background: CMR-aided VT ablation using PSI maps from late gadolinium enhancement-CMR (LGE-CMR), together with electroanatomical map (EAM) information, has been shown to improve outcomes of VT substrate ablation., Methods: Eighty-four patients with scar-dependent monomorphic VT who underwent substrate ablation were included in the study. In the last 28 (33%) consecutive patients, the procedure was guided by CMR. Procedural data, as well as acute and follow-up outcomes, were compared between patients who underwent guided CMR and 2 control groups: 1) patients who had PSI maps were available but the EAM was acquired and used to select the ablation targets (CMR aided); and 2) patients with no CMR-derived PSI maps available (no CMR)., Results: Mean procedure duration was lower in CMR-guided substrate ablation compared with CMR-aided and no CMR (107 ± 59 min vs. 203 ± 68 min and 227 ± 52 min; p < 0.001 for both comparisons). CMR-guided ablation required less fluoroscopy time than CMR-aided ablation and no CMR (10 ± 4 min vs. 23 ± 11 min and 20 ± 9 min, respectively; p < 0.001 for both comparisons) and less radiofrequency time (15 ± 8 min vs. 20 ± 15 min and 26 ± 10 min; p = 0.16 and p < 0.001, respectively). After substrate ablation, VT inducibility was lower in CMR-guided ablation compared with CMR-aided ablation and no CMR (18% vs. 32% and 46%; p = 0.35 and p = 0.04, respectively), without significant differences in complications. After 12 months, VT recurrence was lower in those who underwent CMR-guided ablation compared with no CMR (log-rank: 0.019), with no differences with CMR-aided ablation., Conclusions: CMR-guided VT ablation is feasible and safe, significantly reduces the procedural, fluoroscopy, and radiofrequency times, and is associated with a higher noninducibility rate and lower VT recurrence after substrate ablation., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2020
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34. Follow-Up After Myocardial Infarction to Explore the Stability of Arrhythmogenic Substrate: The Footprint Study.
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Jáuregui B, Soto-Iglesias D, Penela D, Acosta J, Fernández-Armenta J, Linhart M, Terés C, Syrovnev V, Zaraket F, Hervàs V, Prat-González S, Perea RJ, Morales-Ruiz M, Jiménez W, Lasalvia L, Bosch X, Ortiz-Pérez JT, and Berruezo A more...
- Subjects
- Adult, Aged, Cardiac Imaging Techniques, Cicatrix diagnostic imaging, Cicatrix pathology, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium pathology, Stroke Volume physiology, Arrhythmias, Cardiac pathology, Arrhythmias, Cardiac physiopathology, Heart diagnostic imaging, Heart physiopathology, Myocardial Infarction diagnostic imaging, Myocardial Infarction pathology, Myocardial Infarction physiopathology
- Abstract
Objectives: This study aimed to characterize the long-term scar remodeling process after an acute myocardial infarction (AMI) and the underlying scar-related arrhythmogenic substrate using serial late gadolinium enhancement cardiac magnetic resonance (LGE-CMR)., Background: Little is known about the time course needed for completion of the scar healing process after an AMI, which can be assessed by noninvasive cardiac imaging techniques such as LGE-CMR., Methods: Fifty-six patients with revascularized ST-segment elevation AMI (STEMI) were consecutively included. LGE-CMR (3-T) was obtained at 7 days, 6 months, and 4 years after STEMI. The myocardium was segmented into 10 layers from the endocardium to epicardium, characterizing the core, border zone (BZ), and BZ channels (BZCs) using a dedicated post-processing software., Results: Mean age of the patients was 57 ± 11 years; 77% were men. Left ventricular ejection fraction improved at 6 months from 47% to 51% (p < 0.001) and remained stable at 4 years (53%; p = 0.21). Total scar mass decreased from 20.3 ± 14.6 g to 15.3 ± 13.3 g (6 months) and to 12.7 ± 11.7 g (4 years) (p < 0.001). Thirty of 56 (53%) patients showed a mean of 1.5 ± 1.3 BZCs/patient at 7 days, decreasing to 1.2 ± 1.3 (6 months) and 0.8 ± 1.0 (4 years) (p < 0.01). Only 42% of the initial BZCs remained present after 4 years. There were no arrhythmic events after a mean follow-up of 62.5 ± 7.4 months., Conclusions: CMR data post-processing permitted a dynamic assessment of quantitative and qualitative post-AMI scar characteristics. Scar size and number of BZCs steadily decreased 4 years after AMI. BZC distribution was significantly modified during this time. These dynamic parameters could be reliably assessed with CMR; their evaluation might be of prognostic value., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2020
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35. Mortality and morbidity reduction after frequent premature ventricular complexes ablation in patients with left ventricular systolic dysfunction.
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Berruezo A, Penela D, Jáuregui B, Soto-Iglesias D, Aguinaga L, Ordóñez A, Fernández-Armenta J, Martínez M, Tercedor L, Bisbal F, Acosta J, Martí-Almor J, Aceña M, Anguera I, Rossi L, Linhart M, Borràs R, Doltra A, Sánchez P, Ortiz-Pérez JT, Perea RJ, Prat-González S, Teres C, and Bosch X more...
- Subjects
- Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Stroke Volume, Systole, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left physiopathology, Ventricular Premature Complexes mortality, Ventricular Premature Complexes physiopathology, Catheter Ablation methods, Ventricular Dysfunction, Left surgery, Ventricular Premature Complexes surgery
- Abstract
Aims: Ablation of frequent premature ventricular complexes (PVCs) improves left ventricular ejection fraction in patients with left ventricular (LV) systolic dysfunction. This study aims to evaluate the long-term hard outcomes and potential prognostic variables in this population., Methods and Results: Prospective multicentre study including 101 consecutive patients [56 ± 12 years old, 62 (61%) men] with LV systolic dysfunction and frequent PVCs who underwent PVC ablation before November 2015. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Mean follow-up was 34 ± 16 months (range 24-84 months). Ablation was successful in 95 (94%) patients. There was a significant reduction in the PVC burden from 21 ± 12% at baseline to 3.8 ± 6% at LTFUP, P < 0.001. Left ventricular ejection fraction improved from 32 ± 8% at baseline to 39 ± 12% at LTFUP (P < 0.001) and New York Heart Association class from 2.2 ± 0.6% to 1.3 ± 0.6% (P < 0.001). Brain natriuretic peptide levels decreased from 136 (78-321) to 68 (32-144) pg/mL (P = 0.007). Most of this improvement occurs during the first 6 months after ablation. Persistent abolition of at least 18 points of the baseline PVC burden was independently and inversely associated with the composite endpoint of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up [hazard ratio 0.18 (0.05-0.66), P = 0.01]., Conclusion: In patients with LV systolic dysfunction, ablation of frequent PVCs induces a significant improvement in functional, structural, and neurohormonal status, which persists at LTFUP. A sustained reduction in the baseline PVC burden is associated with a lower risk of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.) more...
- Published
- 2019
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36. Image-based criteria to identify the presence of epicardial arrhythmogenic substrate in patients with transmural myocardial infarction.
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Soto-Iglesias D, Acosta J, Penela D, Fernández-Armenta J, Cabrera M, Martínez M, Vassanelli F, Alcaine A, Linhart M, Jáuregui B, Efimova E, Perea RJ, Prat-González S, Ortiz-Pérez JT, Bosch X, Mont L, Camara O, and Berruezo A more...
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- Aged, Female, Follow-Up Studies, Humans, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Cine, Male, Multidetector Computed Tomography, Myocardial Infarction diagnosis, Reproducibility of Results, Retrospective Studies, Tachycardia, Ventricular etiology, Tachycardia, Ventricular physiopathology, Epicardial Mapping methods, Heart Rate physiology, Myocardial Infarction complications, Tachycardia, Ventricular diagnosis
- Abstract
Background: Patients with transmural myocardial infarction (MI) who undergo endocardial-only substrate ablation are at increased risk for ventricular tachycardia recurrence. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) can be used to assess infarct transmurality (IT). However, the degree of IT associated with an epicardial arrhythmogenic substrate (AS) has not been determined., Objective: The purpose of this study was to determine the degree of IT observed by LGE-CMR and multidetector computed tomography (MDCT) that predicts the presence of epicardial AS., Methods: The study included 38 post-MI patients. Ten patients with a subendocardial infarction underwent endocardial-only mapping, and 28 with a classic transmural MI (C-TMI), defined as hyperenhancement ≥75% of myocardial wall thickness (WT), underwent endo-epicardial mapping. LGE-CMR/MDCT data were registered to high-density endocardial or epicardial maps to be analyzed for the presence of AS., Results: Of the 28 post-MI patients with C-TMI, 18 had epicardial AS (64%) and 10 (36%) did not. An epicardial scar area ≥14 cm
2 on LGE-CMR identified patients with epicardial AS (sensitivity 1, specificity 1). Mean WT in the epicardial scar area in these patients was lower than in patients without epicardial AS (3.14 ± 1.16 mm vs 5.54 ± 1.78 mm; P = .008). A mean WT cutoff value ≤3.59 mm identified patients with epicardial AS (sensitivity 0.91, specificity 0.93)., Conclusion: An epicardial scar area ≥14 cm2 on LGE-CMR and mean CT-WT ≤3.59 mm predict epicardial AS in post-MI patients., (Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.) more...- Published
- 2018
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37. Clinical recognition of pure premature ventricular complex-induced cardiomyopathy at presentation.
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Penela D, Fernández-Armenta J, Aguinaga L, Tercedor L, Ordoñez A, Bisbal F, Acosta J, Rossi L, Borras R, Doltra A, Ortiz-Pérez JT, Bosch X, Perea RJ, Prat-González S, Soto-Iglesias D, Tolosana JM, Vassanelli F, Cabrera M, Linhart M, Martinez M, Mont L, and Berruezo A more...
- Subjects
- Cardiomyopathies physiopathology, Electrocardiography, Ambulatory, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Ventricular Premature Complexes physiopathology, Ventricular Premature Complexes surgery, Cardiomyopathies etiology, Catheter Ablation methods, Stroke Volume physiology, Ventricular Function, Left physiology, Ventricular Premature Complexes complications
- Abstract
Background: Frequent premature ventricular complexes (PVCs) can induce or worsen left ventricular (LV) systolic dysfunction., Objective: The purpose of this study was to identify the clinical pattern of patients having a "pure PVC-induced" cardiomyopathy at presentation., Methods: This prospective multicenter study included 155 consecutive patients (age 55 ± 12 years, 96 men [62%], 23% ±12% mean PVC burden) with LV dysfunction and frequent PVCs submitted for ablation and followed up for at least 12 months. Patients with a previously diagnosed structural heart disease (50 [32%]) and those without complete PVC abolition during follow-up who did not normalize LV ejection fraction (LVEF) (24 [15%]) were excluded from the analysis., Results: Of the remaining 81 patients, 41 (51%) had a successful sustained ablation, did not have normalized LVEF, and were classified as having PVC-worsened nonischemic cardiomyopathy, and 40 (49%) who had normalized LVEF were considered as having pure PVC-induced cardiomyopathy. The latter group had higher baseline PVC burden (27% ± 12% vs 12% ± 8%; P <.001), smaller LV end-diastolic diameter (58 ± 5 mm vs 60 ± 6 mm; P = .05), and shorter intrinsic QRS (105 ± 12 vs 129 ± 24 ms; P <.001). Any of the following baseline characteristics accurately identified patients who will not normalize LVEF after PVC ablation (85% sensitivity, 98% specificity): intrinsic QRS >130 ms, baseline PVC burden <17%, and LV end-diastolic diameter >63 mm., Conclusion: Almost half of patients with frequent PVCs and low LVEF of unknown origin normalize LVEF after sustained PVC abolition, and these patients can be identified before ablation., (Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2017
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38. Cardiac magnetic resonance-aided scar dechanneling: Influence on acute and long-term outcomes.
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Andreu D, Penela D, Acosta J, Fernández-Armenta J, Perea RJ, Soto-Iglesias D, de Caralt TM, Ortiz-Perez JT, Prat-González S, Borràs R, Guasch E, Tolosana JM, Mont L, and Berruezo A
- Subjects
- Acute Disease, Aged, Catheter Ablation adverse effects, Cicatrix pathology, Electrophysiologic Techniques, Cardiac methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors, Stroke Volume, Tachycardia, Ventricular physiopathology, Tachycardia, Ventricular surgery, Time Factors, Treatment Outcome, Ventricular Remodeling, Catheter Ablation methods, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Cine methods, Myocardium pathology, Postoperative Complications, Tachycardia, Ventricular pathology, Ventricular Function, Left physiology
- Abstract
Background: Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) provides tissue characterization of ventricular myocardium and scar that can be depicted as pixel signal intensity (PSI) maps., Objective: To assess the possible benefit of guiding the ventricular tachycardia (VT) substrate mapping by integrating these PSI maps into the navigation system., Methods: In total, 159 consecutive patients (66 ± 11 years old, 151 men [95%]) with scar-related left ventricular (LV) VT were included. VT substrate ablation used the scar dechanneling technique. A CMR-aided ablation using the PSI maps was performed in 54 patients (34%). Procedural data as well as acute and long-term outcomes were compared with those of the remaining 105 patients (66%)., Results: Mean procedure duration and fluoroscopy time were 229 ± 67 minutes and 20 ± 9 minutes, respectively, without significant differences between groups. Both the number of radiofrequency (RF) applications and RF delivery time were lower in the CMR-aided group (28 ± 18 applications vs 36 ± 18 applications, P = .037, and 19 ± 12 minutes vs 27 ± 16 minutes, P = .009, respectively). After substrate ablation, monomorphic VT inducibility was lower in the CMR-aided than in the control group (17 [32%] vs 53 [51%] patients, P = .022). After a mean follow-up period of 20 ± 19 months, patients from the CMR-aided group had a lower recurrence rate than those in the control group (10 patients [18.5%] vs 46 patients [43.8%], respectively, P = .002; log-rank P = .017). Multivariate analysis found that CMR-aided ablation (hazard ratio, 0.48 [95% Confirdence Interval (CI) 0.24-0.96], P = .037) was an independent predictor of recurrences., Conclusion: CMR-aided scar dechanneling is associated with a lower need for RF delivery, higher noninducibility rates after substrate ablation, and a higher VT-recurrence-free survival., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.) more...
- Published
- 2017
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39. Left atrial fibrosis quantification by late gadolinium-enhanced magnetic resonance: a new method to standardize the thresholds for reproducibility.
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Benito EM, Carlosena-Remirez A, Guasch E, Prat-González S, Perea RJ, Figueras R, Borràs R, Andreu D, Arbelo E, Tolosana JM, Bisbal F, Brugada J, Berruezo A, and Mont L
- Subjects
- Action Potentials, Adolescent, Adult, Aged, Atrial Fibrillation pathology, Atrial Fibrillation physiopathology, Atrial Fibrillation surgery, Cardiac-Gated Imaging Techniques, Case-Control Studies, Catheter Ablation, Electrocardiography, Electrophysiologic Techniques, Cardiac, Female, Fibrosis, Heart Atria pathology, Heart Atria physiopathology, Heart Atria surgery, Humans, Male, Middle Aged, Predictive Value of Tests, Reference Values, Reproducibility of Results, Young Adult, Atrial Fibrillation diagnostic imaging, Atrial Remodeling, Contrast Media administration & dosage, Heart Atria diagnostic imaging, Magnetic Resonance Imaging standards, Organometallic Compounds administration & dosage
- Abstract
Aims: Identification of left atrial (LA) fibrosis through late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) remains controversial due to the heterogeneity and lack of reproducibility of proposed methods. Our aim is to describe a normalized, reproducible, standardized method to evaluate LA fibrosis through LGE-CMR., Methods and Results: Electrocardiogram- and respiratory-gated 3-Tesla LGE-CMR was performed in 10 healthy young volunteers and 30 patients with atrial fibrillation (AF): 10 with paroxysmal AF, 10 with persistent AF, and 10 with a previous AF ablation procedure. Local image intensity ratio (IIR) of the LA was calculated as the absolute pixel intensity to mean blood pool intensity ratio. The healthy atrial tissue threshold was defined in young healthy volunteers (upper limit of normality set at IIR tissue mean plus 2 SDs). Dense atrial scarring was characterized in patients with previous radiofrequency-induced scarring (post-AF ablation patients). Validation groups consisted of patients with paroxysmal and persistent AFs. The upper limit of normal IIR was 1.20; IIR values higher than 1.32 (60% of mean maximum pixel intensity in post-ablation patients) were considered dense scar. Image intensity ratio values between 1.2 and 1.32 identified interstitial fibrosis. Patients with paroxysmal and persistent AFs had less atrial fibrotic tissue compared with post-ablation patients. Endocardial bipolar voltage was correlated to IIR values., Conclusions: An IIR of 1.2 identifies the upper limit of normality in healthy young individuals. An IIR of >1.32 defines dense atrial fibrosis in post-ablation patients. Our results provide a consistent, comparable, and normalized tool to assess atrial arrhythmogenic substrate., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.) more...
- Published
- 2017
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40. Septal myectomy after failed septal alcohol ablation.
- Author
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Quintana E, Bajona P, Arguis MJ, and Prat-González S
- Abstract
Despite septal myectomy remaining the gold standard septal reduction therapy for hypertrophic obstructive cardiomyopathy (HOCM), there has been a disproportionate use of alcohol septal ablation (ASA) worldwide. Absolute resolution of left ventricular outflow tract (LVOT) obstruction with ASA is not achieved in a substantial proportion of patients. The mechanisms of failure from ASA are partially understood and described. Residual obstruction in hypertrophic cardiomyopathy is associated with worse clinical outcomes and mortality. There is a growing number of patients who present with significant residual gradients after ASA and require a rescue septal myectomy operation, which then carries an increased risk of perioperative complications and life-long sequelae. This contrasts with the excellent outcomes achieved by septal myectomy without previous percutaneous intervention. Despite complete resolution of obstruction in rescue myectomy, the outcomes remain compromised by the prior ASA., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare. more...
- Published
- 2017
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41. Eosinophilic granulomatosis with polyangitis (Churg-Strauss) and severe pericardial effusion.
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Pujol-López M, Prieto-González S, Prat-González S, and Hernández-Rodríguez J
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- Churg-Strauss Syndrome complications, Echocardiography, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Pericardial Effusion diagnostic imaging, Radiography, Churg-Strauss Syndrome diagnostic imaging, Pericardial Effusion etiology
- Published
- 2017
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42. Safety, long-term outcomes and predictors of recurrence after first-line combined endoepicardial ventricular tachycardia substrate ablation in arrhythmogenic cardiomyopathy. Impact of arrhythmic substrate distribution pattern. A prospective multicentre study.
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Berruezo A, Acosta J, Fernández-Armenta J, Pedrote A, Barrera A, Arana-Rueda E, Bodegas AI, Anguera I, Tercedor L, Penela D, Andreu D, Perea RJ, Prat-González S, and Mont L
- Subjects
- Adult, Arrhythmogenic Right Ventricular Dysplasia diagnosis, Causality, Combined Modality Therapy mortality, Combined Modality Therapy statistics & numerical data, Comorbidity, Endocardium surgery, Female, Humans, Longitudinal Studies, Male, Middle Aged, Pericardium surgery, Prevalence, Recurrence, Risk Factors, Secondary Prevention statistics & numerical data, Spain epidemiology, Survival Rate, Tachycardia, Ventricular diagnosis, Treatment Outcome, Arrhythmogenic Right Ventricular Dysplasia mortality, Arrhythmogenic Right Ventricular Dysplasia surgery, Catheter Ablation mortality, Catheter Ablation statistics & numerical data, Tachycardia, Ventricular mortality, Tachycardia, Ventricular prevention & control
- Abstract
Background: First-line endoepicardial ventricular tachycardia (VT) ablation has been proposed for patients with arrhythmogenic cardiomyopathy (AC). This study reports procedural safety, outcomes, and predictors of recurrence., Methods and Results: Forty-one consecutive patients [12 with left ventricle (LV) involvement, 7 left-dominant] underwent first-line endoepicardial VT substrate ablation. Standard bipolar and unipolar thresholds were used to define low-voltage areas (LVA). Arrhythmogenic substrate area (ASA) was defined as the area containing electrograms with delayed components. Implantable cardioverter defibrillator interrogations were evaluated for VT recurrence. Epicardial LVA was larger in all cases (102.5 ± 78.6 vs. 19.3 ± 24.4 cm2; P< 0.001). Consistent with an epicardium-to-endocardium arrhythmogenic substrate progression pattern, epicardial ASA (epi-ASA) was negatively correlated with bipolar endocardial LVA (r = -0.368; P= 0.035) and with endocardial bipolar/unipolar-LVA (Bi/Uni-LVA) ratio (r= -0.38; P= 0.037). A Bi/Uni-LVA ratio >0.23 predicted an epi-ASA ≤10 cm2 (100% sensitivity, 84% specificity). Patients showing an epi-ASA < 10 cm2 required less epicardial (8.4 ± 5.8 vs. 25.3 ± 16; P= 0.045) and more endocardial (16.5 ± 8.6 vs. 7.5 ± 8.2; P= 0.047) radiofrequency applications. One patient with epi-ASA < 10 cm2 died of cardiac tamponade after epicardial puncture. Acute success (no VT inducibility after procedure) was achieved in 36 patients (90%). After 32.2 ± 21.8 months, 11 (26.8%) patients had VT recurrences. Left-dominant AC was associated with an increased risk of recurrence (HR = 3.41 [1.1-11.2], P= 0.044; log-rank P= 0.021)., Conclusion: First-line endoepicardial VT substrate ablation achieves good long-term results in AC. Left-dominant AC is associated with an increased risk of recurrence. The Bi/Uni-LVA ratio identifies patients with limited epicardial arrhythmogenic substrate in whom the indication of epicardial approach should be more cautiously assessed., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.) more...
- Published
- 2017
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43. Utility of galectin-3 in predicting post-infarct remodeling after acute myocardial infarction based on extracellular volume fraction mapping.
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Perea RJ, Morales-Ruiz M, Ortiz-Perez JT, Bosch X, Andreu D, Borras R, Acosta J, Penela D, Prat-González S, de Caralt TM, Martínez M, Morales-Romero B, Lasalvia L, Donnelly J, Jiménez W, Mira A, Mont L, and Berruezo A more...
- Subjects
- Biomarkers blood, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Myocardium pathology, Prognosis, Prospective Studies, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction physiopathology, Extracellular Matrix pathology, Galectin 3 blood, ST Elevation Myocardial Infarction blood, Ventricular Function, Left physiology, Ventricular Remodeling physiology
- Abstract
Aims: ST-segment elevation myocardial infarction (STEMI) triggers remote extracellular matrix expansion. Myocardial extracellular volume fraction (ECV), determined by cardiovascular magnetic resonance, permits quantification of interstitial space expansion. Our aim was to determine the relationship between early serum fibrosis biomarkers and 180-day post-infarct remote myocardium remodeling using ECV., Methods and Results: In 26 patients with STEMI, functional imaging, T1-mapping, and late-gadolinium-enhancement were performed on a 3-T CMR scanner at baseline (days 3 to 5) and 180days. Biomarkers were measured at days 1, 3, and 7 after STEMI. The mean initial and follow-up left ventricular ejection fraction (LVEF) were 48.3±18.1% and 52.6±12.3%, respectively. Initial infarct size was 11.6±16.8% of LV mass. ECV in the remote myocardium at 180days correlated with indexed end-systolic volume (r=0.4, p=0.045). A significant correlation was observed between galectin-3 at day 7 and ECV at 6months (r=0.428, p=0.037). A trend towards a direct correlation was found for BNP (r=0.380, p=0.059). Multivariate analysis revealed that BNP and galectin-3 were independent predictors of long-term changes in ECV and explained nearly 30% of the variance in this parameter (r
2 =0.34; p=0.01). A galectin-3 cutoff value of 10.15ng/mL was the most powerful predictor of high ECV values (≥28.5%) at follow-up. Galectin-3 at day 7 was an independent predictor of high ECV values at follow-up (OR=22.51; CI 95%: 2.1-240.72; p=0.01) with 0.76 AUC (CI: 0.574-0.964; p=0.03)., Conclusions: Galectin-3 measured acutely after STEMI is an independent predictor of increased ECV at 6-month follow-up that might be useful for long-term risk stratification., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.) more...- Published
- 2016
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44. Left Atrial Geometry Improves Risk Prediction of Thromboembolic Events in Patients With Atrial Fibrillation.
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Bisbal F, Gómez-Pulido F, Cabanas-Grandío P, Akoum N, Calvo M, Andreu D, Prat-González S, Perea RJ, Villuendas R, Berruezo A, Sitges M, Bayés-Genís A, Brugada J, Marrouche NF, and Mont L
- Subjects
- Aged, Area Under Curve, Atrial Appendage physiopathology, Atrial Fibrillation complications, Atrial Fibrillation physiopathology, Chi-Square Distribution, Female, Humans, Image Interpretation, Computer-Assisted, Imaging, Three-Dimensional, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Prognosis, ROC Curve, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Spain, Stroke diagnosis, Thromboembolism blood, Thromboembolism diagnosis, Utah, Atrial Appendage diagnostic imaging, Atrial Fibrillation diagnostic imaging, Atrial Function, Left, Atrial Remodeling, Blood Coagulation, Coronary Angiography methods, Magnetic Resonance Angiography, Stroke etiology, Thromboembolism etiology
- Abstract
Background: Left atrial (LA) sphericity (LASP) is a new remodeling parameter based on LA shape analysis, with independent predictive value for recurrence after atrial fibrillation (AF) ablation., Objectives: To evaluate the association between LASP and thromboembolic events (TE) in patients with AF., Methods: Twenty-nine AF patients and prior TE and 29 age- and gender-matched controls were included. LASP was calculated using a 3D-LA reconstruction. The LA appendage (LAA) volume and morphology were assessed. ROC curve analysis was performed for LASP, LA volume, LAA volume, and CHAD/CHA2 D-VASc scores (Stroke2 -the grouping variable-was excluded)., Results: Mean age of the study population was 61 ± 11 years (79.3% males, 53.4% hypertension, 8.6% diabetes). Patients with prior TE had higher LASP than those without (82.5 ± 3.3% vs. 80.2 ± 3.1%, P = 0.008); there were no differences in CHAD or CHA2 D-VASc scores, LA volume, LAA volume, or LAA morphology. The C-statistic was higher for LASP (0.71) than for other tested variables (CHAD score = 0.58, CHA2 D-VASc score = 0.59, LA volume = 0.50, LAA volume = 0.46; P < 0.01 for all vs. LASP). The best cutoff value for LASP was 83.6% (sensitivity 0.52, specificity 0.90). Logistic regression analysis showed predictive value for LASP (OR 1.26 per each 1% increase [1.85-52.20], P = 0.013), but not for clinical risk scores. The addition of LASP to the CHAD and CHA2 D-VASc scores increased the predictive value over the risk scores alone (P = 0.004), and reclassified 45.5% of patients with CHAD = 0 (no anticoagulation indicated) to moderate-risk (anticoagulation indicated)., Conclusion: LA sphericity is associated with prior TE in AF patients and improves the performance of the CHAD and CHA2 D-VASc scores alone., (© 2016 Wiley Periodicals, Inc.) more...
- Published
- 2016
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45. Parametric techniques for characterizing myocardial tissue by magnetic resonance imaging (part 1): T1 mapping.
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Perea Palazón RJ, Ortiz Pérez JT, Prat González S, de Caralt Robira TM, Cibeira López MT, and Solé Arqués M
- Subjects
- Cardiomyopathies, Fibrosis diagnostic imaging, Humans, Cardiac Imaging Techniques methods, Heart diagnostic imaging, Magnetic Resonance Imaging, Myocardium pathology
- Abstract
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.) more...
- Published
- 2016
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46. Valvular Heart Disease Epidemics.
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Domenech B, Pomar JL, Prat-González S, Vidal B, López-Soto A, Castella M, and Sitges M
- Subjects
- Adult, Aged, Aged, 80 and over, Aortic Valve Insufficiency epidemiology, Aortic Valve Stenosis epidemiology, Female, Heart Valve Diseases diagnosis, Heart Valve Diseases therapy, Humans, Male, Middle Aged, Mitral Valve Insufficiency epidemiology, Mitral Valve Stenosis epidemiology, Prevalence, Retrospective Studies, Risk Factors, Spain epidemiology, Cardiology Service, Hospital statistics & numerical data, Geriatrics statistics & numerical data, Heart Valve Diseases epidemiology
- Abstract
BACKGROUND AIM OF THE STUDY: The real burden of valvular heart disease (VHD) is scarcely known, as several factors may potentially lead to its increased prevalence. The study aim was to assess the prevalence of VHD and its treatment in the authors' environment to plan the healthcare requisites for optimal management of the condition. METHODS: A retrospective analysis was conducted of data acquired from patients who had been assessed at different consultation levels for cardiovascular disorders during a six-month period between January and June 2014 in public health referral area of 500,00 inhabitants. Patients included were those admitted to hospital cardiology, cardiac surgery and geriatric care units (n = 1,083), as well as ambulatory patients attending cardiology-specific outpatient clinics at the authors' hospital or at two ascribed primary care centers (n = 852). Data were registered regarding the epidemiology, etiology, echocardiography and treatment of patients in whom VHD was detected. RESULTS: Among a total of 1,935 adult patients, moderate or severe valve disease was identified in 453 cases (23.4%) who were evaluated for cardiovascular disease. The prevalence of VHD increased with age. Multivalvular moderate-severe dysfunction was present in two valves in 33% and in three valves in 5.7% of patients. Significant mitral valve disease was present in 39% and aortic valve disease in 48% of patients. The etiology of the valvular lesions was degenerative in 60%, functional in 15.5%, rheumatic in almost 10%, congenital in 6%, due to endocarditis in only 3%. Patients with VHD represented up to 24.2% of the in-hospital admissions. An interventional treatment was required in 55% of the patients (mostly surgical valve procedures). CONCLUSION: The present study results showed that VHD is a frequent occurrence and is increasingly prevalent with age, constituting up to one-fourth of all in-hospital admissions for cardiovascular disease. VHD is a growing public health problem that should be addressed with appropriate resources to improve research into its nature, diagnosis and treatment. more...
- Published
- 2016
47. 3D delayed-enhanced magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation.
- Author
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Andreu D, Ortiz-Pérez JT, Fernández-Armenta J, Guiu E, Acosta J, Prat-González S, De Caralt TM, Perea RJ, Garrido C, Mont L, Brugada J, and Berruezo A
- Subjects
- Aged, Cardiomyopathies complications, Catheter Ablation methods, Cicatrix etiology, Cohort Studies, Contrast Media, Female, Fibrosis, Gadolinium DTPA, Humans, Imaging, Three-Dimensional, Magnetic Resonance Imaging, Cine methods, Male, Middle Aged, Myocardial Infarction complications, Myocardial Ischemia complications, Myocardial Ischemia pathology, Surgery, Computer-Assisted, Tachycardia, Ventricular etiology, Tachycardia, Ventricular pathology, Cardiomyopathies pathology, Cicatrix pathology, Magnetic Resonance Imaging methods, Myocardial Infarction pathology, Myocardium pathology, Tachycardia, Ventricular surgery
- Abstract
Aims: Non-invasive depiction of conducting channels (CCs) is gaining interest for its usefulness in ventricular tachycardia (VT) ablation. The best imaging approach has not been determined. We compared characterization of myocardial scar with late-gadolinium enhancement cardiac magnetic resonance using a navigator-gated 3D sequence (3D-GRE) and conventional 2D imaging using either a single shot inversion recovery steady-state-free-precession (2D-SSFP) or inversion-recovery gradient echo (2D-GRE) sequence., Methods and Results: We included 30 consecutive patients with structural heart disease referred for VT ablation. Preprocedural myocardial characterization was conducted in a 3 T-scanner using 2D-GRE, 2D-SSFP and 3D-GRE sequences, yielding a spatial resolution of 1.4 × 1.4 × 5 mm, 2 × 2 × 5 mm, and 1.4 × 1.4 × 1.4 mm, respectively. The core and border zone (BZ) scar components were quantified using the 60% and 40% threshold of maximum pixel intensity, respectively. A 3D scar reconstruction was obtained for each sequence. An electrophysiologist identified potential CC and compared them with results obtained with the electroanatomic map (EAM). We found no significant differences in the scar core mass between the 2D-GRE, 2D-SSFP, and 3D-GRE sequences (mean 7.48 ± 6.68 vs. 8.26 ± 5.69 and 6.26 ± 4.37 g, respectively, P = 0.084). However, the BZ mass was smaller in the 2D-GRE and 2D-SSFP than in the 3D-GRE sequence (9.22 ± 5.97 and 9.39 ± 6.33 vs. 10.92 ± 5.98 g, respectively; P = 0.042). The matching between the CC observed in the EAM and in 3D-GRE was 79.2%; when comparing the EAM and the 2D-GRE and the 2D-SSFP sequence, the matching decreased to 61.8% and 37.7%, respectively., Conclusion: 3D scar reconstruction using images from 3D-GRE sequence improves the overall delineation of CC prior to VT ablation., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.) more...
- Published
- 2015
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48. Usefulness of contrast-enhanced cardiac magnetic resonance in identifying the ventricular arrhythmia substrate and the approach needed for ablation.
- Author
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Andreu D, Ortiz-Pérez JT, Boussy T, Fernández-Armenta J, de Caralt TM, Perea RJ, Prat-González S, Mont L, Brugada J, and Berruezo A
- Subjects
- Arrhythmias, Cardiac surgery, Contrast Media, Electrocardiography, Electrophysiologic Techniques, Cardiac methods, Female, Humans, Magnetic Resonance Angiography methods, Male, Middle Aged, Treatment Outcome, Arrhythmias, Cardiac diagnosis, Catheter Ablation methods
- Abstract
Aims: The endocardial vs. epicardial origin of ventricular arrhythmia (VA) can be inferred from detailed electrocardiogram (ECG) analysis. However, despite its clinical usefulness, ECG has limitations. Alternatively, scarred tissue sustaining VAs can be identified by contrast-enhanced cardiac magnetic resonance (ce-CMR). The objective of this study was to determine the clinical value of analysing the presence and distribution pattern of scarred tissue in the ventricles to identify the VA site of origin and the ablation approach required., Methods and Results: A ce-CMR study was carried out before the index ablation procedure in a cohort of 80 patients with non-idiopathic VA. Hyper-enhancement (HE) in each ventricular segment was coded as absent, subendocardial, transmural, mid-myocardial, or epicardial. The endocardial or epicardial VA site of origin was also assigned according to the approach needed for ablation. The clinical VA was successfully ablated in 77 (96.3%) patients, all of them showing HE on ce-CMR. In segments with successful ablation of the clinical ventricular tachycardia, HE was absent in 3 (3.9%) patients, subendocardial in 19 (24.7%), transmural in 36 (46.7%), mid-myocardial in 8 (10.4%), and subepicardial in 11 (14.3%) patients. Epicardial ablation of the index VA was necessary in 3 (6.1%) ischaemic and 12 (42.9%) non-ischaemic patients. The presence of subepicardial HE in the successful ablation segment had 84.6% sensitivity and 100% specificity in predicting an epicardial origin of the VA., Conclusion: Contrast-enhanced cardiac magnetic resonance is helpful to localize the target ablation substrate of non-idiopathic VA and also to plan the approach needed, especially in non-ischaemic patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.) more...
- Published
- 2014
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49. Carvedilol administration in acute myocardial infarction results in stronger inhibition of early markers of left ventricular remodeling than metoprolol.
- Author
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Cimmino G, Ibanez B, Giannarelli C, Prat-González S, Hutter R, Garcia M, Sanz J, Fuster V, and Badimon JJ
- Subjects
- Animals, Biomarkers metabolism, Carbazoles pharmacology, Carvedilol, Metoprolol pharmacology, Myocardial Infarction metabolism, Myocardial Infarction pathology, Propanolamines pharmacology, Random Allocation, Swine, Ventricular Remodeling physiology, Carbazoles therapeutic use, Down-Regulation drug effects, Metoprolol therapeutic use, Myocardial Infarction drug therapy, Propanolamines therapeutic use, Ventricular Remodeling drug effects
- Abstract
Background: The structural secuelae of acute myocardial infarction (AMI) is mostly dictated by left ventricular (LV) remodelling, leading to heart failure. Monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) play a critical role in LV remodelling. β-blockers are first line therapy for AMI and heart failure; however, the mechanisms responsible for their benefits remain poorly understood. Different β-blocker agents have been shown to exert beneficial activities both in AMI and heart failure, however, their role in early remodelling after ischemia/reperfusion is to be fully elucidated. We sought to compare the effect of 2 of the most prescribed β-blocker agents in early markers of LV remodelling after AMI., Methods: A reperfused AMI was induced in Yorshire pigs, being randomized to early intravenous carvedilol, metoprolol or placebo. Twenty-four hours after reperfusion markers of early remodelling were addressed in the LV., Results: The early administration of both β-blockers is able to significantly reduce macrophage infiltration as well as the expression and activity of MCP-1 and MMP-2 compared to placebo. The effects of carvedilol were much stronger than those of metoprolol. Conversely, carvedilol upregulated the expression TIMP-2 to a greater extent than metoprolol., Conclusions: In an AMI model closely mimicking human pathophysiology, the early administration of carvedilol reduced the expression of markers associated with early LV remodelling to greater extent than metoprolol. These findings may explain the superior clinical benefits exerted by carvedilol in heart failure., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.) more...
- Published
- 2011
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50. [Apical aneurysm in a full-contact fighter].
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Noble S, Sunthorn H, and Prat-González S
- Subjects
- Adult, Anabolic Agents adverse effects, Coitus, Coronary Vessels injuries, Defibrillators, Implantable, Electrocardiography, Heart Aneurysm physiopathology, Humans, Male, Steroids adverse effects, Tachycardia, Ventricular etiology, Tachycardia, Ventricular physiopathology, Thoracic Injuries physiopathology, Wounds, Nonpenetrating physiopathology, Boxing injuries, Heart Aneurysm diagnosis, Heart Aneurysm etiology, Thoracic Injuries complications, Thoracic Injuries diagnosis, Wounds, Nonpenetrating complications, Wounds, Nonpenetrating diagnosis
- Published
- 2011
- Full Text
- View/download PDF
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