Stasis imaging predicts the risk of cardioembolic events related to acute myocardial infarction: the ISBITAMI study

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 com...

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Detalles Bibliográficos
Autores: Rodríguez González, Elena, Martínez-Legazpi Aguilo, Pablo, Mombiela, Teresa, González Mansilla, Ana, Delgado Montero, Antonia, Guzmán-De-Villoria, Juan A., Díaz Otero, Fernando, Prieto Arévalo, Raquel, Juárez, Miriam, García del Rey, María del Carmen, Fernández-García, Pilar, Flores, Óscar, Postigo, Andrea, Yotti, Raquel, García Villalba, Manuel, Fernández Avilés, Francisco, Álamo, Juan C. del, Bermejo, Javier
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universidad Nacional de Educación a Distancia
Repositorio:e-spacio. Repositorio Institucional de la UNED
Idioma:inglés
OAI Identifier:oai:e-spacio.uned.es:20.500.14468/25824
Acceso en línea:https://hdl.handle.net/20.500.14468/25824
Access Level:acceso abierto
Palabra clave:23 Química::2302 Bioquímica ::2302.26 Bioquímica física
ischemic stroke
ST-segment elevation myocardial infarction
echocardiography
blood stasis
cardioembolism
Descripción
Sumario: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).

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