Elena Rodríguez-González , Pablo Martínez-Legazpi , Teresa Mombiela , Ana González-Mansilla , Antonia Delgado-Montero , Juan A. Guzmán-De-Villoria , Fernando Díaz-Otero , Raquel Prieto-Arévalo , Miriam Juárez , María del Carmen García del Rey , Pilar Fernández-García , Óscar Flores , Andrea Postigo , Raquel Yotti , Manuel García-Villalba , Francisco Fernández-Avilés , Juan C. del Álamo , Javier Bermejo
{"title":"瘀血成像预测急性心肌梗死后心肌栓塞事件的风险：ISBITAMI 研究","authors":"Elena Rodríguez-González , Pablo Martínez-Legazpi , Teresa Mombiela , Ana González-Mansilla , Antonia Delgado-Montero , Juan A. Guzmán-De-Villoria , Fernando Díaz-Otero , Raquel Prieto-Arévalo , Miriam Juárez , María del Carmen García del Rey , Pilar Fernández-García , Óscar Flores , Andrea Postigo , Raquel Yotti , Manuel García-Villalba , Francisco Fernández-Avilés , Juan C. del Álamo , Javier Bermejo","doi":"10.1016/j.recesp.2024.04.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>In the setting of ST-segment elevation myocardial infarction (STEMI), imaging-based biomarkers could be useful for guiding oral anticoagulation to prevent cardioembolism. Our objective was to test the efficacy of intraventricular blood stasis imaging for predicting a composite primary endpoint of cardioembolic risk during the first 6 months after STEMI.</div></div><div><h3>Methods</h3><div>We designed a prospective clinical study, Imaging Silent Brain Infarct in Acute Myocardial Infarction (ISBITAMI), including patients with a first STEMI, an ejection fraction ≤ 45% and without atrial fibrillation to assess the performance of stasis metrics to predict cardioembolism. Patients underwent ultrasound-based stasis imaging at enrollment followed by heart and brain magnetic resonance at 1-week and 6-month visits. From the stasis maps, we calculated the average residence time, <em>R</em><sub><em>T</em></sub>, of blood inside the left ventricle and assessed its performance to predict the primary endpoint. The longitudinal strain of the 4 apical segments was quantified by speckle tracking.</div></div><div><h3>Results</h3><div>A total of 66 patients were assigned to the primary endpoint. Of them, 17 patients had 1 or more events: 3 strokes, 5 silent brain infarctions, and 13 mural thromboses. No systemic embolisms were observed. <em>R</em><sub><em>T</em></sub> (OR, 3.73; 95%CI, 1.75-7.9; <em>P</em> <!--><<!--> <!-->.001) and apical strain (OR, 1.47; 95%CI, 1.13-1.92; <em>P</em> <!-->=<!--> <!-->.004) showed complementary prognostic value. The bivariate model showed a c-index<!--> <!-->=<!--> <!-->0.86 (95%CI, 0.73-0.95), a negative predictive value of 1.00 (95%CI, 0.94-1.00), and positive predictive value of 0.45 (95%CI, 0.37-0.77). The results were confirmed in a multiple imputation sensitivity analysis. Conventional ultrasound-based metrics were of limited predictive value.</div></div><div><h3>Conclusions</h3><div>In patients with STEMI and left ventricular systolic dysfunction in sinus rhythm, the risk of cardioembolism may be assessed by echocardiography by combining stasis and strain imaging. Registered at ClinicalTrials.gov (NCT02917213).</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 1","pages":"Pages 22-33"},"PeriodicalIF":5.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"La imagen de estasis predice el riesgo de eventos cardioembólicos tras el infarto agudo de miocardio: el estudio ISBITAMI\",\"authors\":\"Elena Rodríguez-González , Pablo Martínez-Legazpi , Teresa Mombiela , Ana González-Mansilla , Antonia Delgado-Montero , Juan A. Guzmán-De-Villoria , Fernando Díaz-Otero , Raquel Prieto-Arévalo , Miriam Juárez , María del Carmen García del Rey , Pilar Fernández-García , Óscar Flores , Andrea Postigo , Raquel Yotti , Manuel García-Villalba , Francisco Fernández-Avilés , Juan C. del Álamo , Javier Bermejo\",\"doi\":\"10.1016/j.recesp.2024.04.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction and objectives</h3><div>In the setting of ST-segment elevation myocardial infarction (STEMI), imaging-based biomarkers could be useful for guiding oral anticoagulation to prevent cardioembolism. Our objective was to test the efficacy of intraventricular blood stasis imaging for predicting a composite primary endpoint of cardioembolic risk during the first 6 months after STEMI.</div></div><div><h3>Methods</h3><div>We designed a prospective clinical study, Imaging Silent Brain Infarct in Acute Myocardial Infarction (ISBITAMI), including patients with a first STEMI, an ejection fraction ≤ 45% and without atrial fibrillation to assess the performance of stasis metrics to predict cardioembolism. Patients underwent ultrasound-based stasis imaging at enrollment followed by heart and brain magnetic resonance at 1-week and 6-month visits. From the stasis maps, we calculated the average residence time, <em>R</em><sub><em>T</em></sub>, of blood inside the left ventricle and assessed its performance to predict the primary endpoint. The longitudinal strain of the 4 apical segments was quantified by speckle tracking.</div></div><div><h3>Results</h3><div>A total of 66 patients were assigned to the primary endpoint. Of them, 17 patients had 1 or more events: 3 strokes, 5 silent brain infarctions, and 13 mural thromboses. No systemic embolisms were observed. <em>R</em><sub><em>T</em></sub> (OR, 3.73; 95%CI, 1.75-7.9; <em>P</em> <!--><<!--> <!-->.001) and apical strain (OR, 1.47; 95%CI, 1.13-1.92; <em>P</em> <!-->=<!--> <!-->.004) showed complementary prognostic value. The bivariate model showed a c-index<!--> <!-->=<!--> <!-->0.86 (95%CI, 0.73-0.95), a negative predictive value of 1.00 (95%CI, 0.94-1.00), and positive predictive value of 0.45 (95%CI, 0.37-0.77). The results were confirmed in a multiple imputation sensitivity analysis. Conventional ultrasound-based metrics were of limited predictive value.</div></div><div><h3>Conclusions</h3><div>In patients with STEMI and left ventricular systolic dysfunction in sinus rhythm, the risk of cardioembolism may be assessed by echocardiography by combining stasis and strain imaging. Registered at ClinicalTrials.gov (NCT02917213).</div></div>\",\"PeriodicalId\":21299,\"journal\":{\"name\":\"Revista espanola de cardiologia\",\"volume\":\"78 1\",\"pages\":\"Pages 22-33\"},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Revista espanola de cardiologia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0300893224001830\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista espanola de cardiologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300893224001830","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
La imagen de estasis predice el riesgo de eventos cardioembólicos tras el infarto agudo de miocardio: el estudio ISBITAMI
Introduction and objectives
In the setting of ST-segment elevation myocardial infarction (STEMI), imaging-based biomarkers could be useful for guiding oral anticoagulation to prevent cardioembolism. Our objective was to test the efficacy of intraventricular blood stasis imaging for predicting a composite primary endpoint of cardioembolic risk during the first 6 months after STEMI.
Methods
We designed a prospective clinical study, Imaging Silent Brain Infarct in Acute Myocardial Infarction (ISBITAMI), including patients with a first STEMI, an ejection fraction ≤ 45% and without atrial fibrillation to assess the performance of stasis metrics to predict cardioembolism. Patients underwent ultrasound-based stasis imaging at enrollment followed by heart and brain magnetic resonance at 1-week and 6-month visits. From the stasis maps, we calculated the average residence time, RT, of blood inside the left ventricle and assessed its performance to predict the primary endpoint. The longitudinal strain of the 4 apical segments was quantified by speckle tracking.
Results
A total of 66 patients were assigned to the primary endpoint. Of them, 17 patients had 1 or more events: 3 strokes, 5 silent brain infarctions, and 13 mural thromboses. No systemic embolisms were observed. RT (OR, 3.73; 95%CI, 1.75-7.9; P < .001) and apical strain (OR, 1.47; 95%CI, 1.13-1.92; P = .004) showed complementary prognostic value. The bivariate model showed a c-index = 0.86 (95%CI, 0.73-0.95), a negative predictive value of 1.00 (95%CI, 0.94-1.00), and positive predictive value of 0.45 (95%CI, 0.37-0.77). The results were confirmed in a multiple imputation sensitivity analysis. Conventional ultrasound-based metrics were of limited predictive value.
Conclusions
In patients with STEMI and left ventricular systolic dysfunction in sinus rhythm, the risk of cardioembolism may be assessed by echocardiography by combining stasis and strain imaging. Registered at ClinicalTrials.gov (NCT02917213).
期刊介绍：
Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.
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