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Martínez-Legazpi Aguilo, Pablo

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legazpi.pablo@ccia.uned.es
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Martínez-Legazpi Aguilo
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Pablo
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20252
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Autor: Delgado Montero, Antonia ×

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Mostrando 1 - 2 de 2
  • Miniatura
    Publicación
    Validation of noninvasive indices of right ventricular diastolic function. Simultaneous echocardiography and pressure-volume catheterization studies
    (Springer, 2025-07-09) Pérez del Villar, Candelas; Prieto Arévalo, Raquel; García Carreño, Jorge; Martínez-Legazpi Aguilo, Pablo; Rodríguez Pérez, Daniel; Benito, Yolanda; Delgado Montero, Antonia; Antoranz Callejo, José Carlos; Desco Menéndez, Mª del Mar; Herrera Flores, Cristian; Corisco Beltrán, Rafael; Fernández Avilés, Francisco; Bermejo, Javier; Instituto de Salud Carlos III; Gerencia Regional de Salud de Castilla y León; EU – European Regional Development Fund; Instituto de Investigación Sanitaria Gregorio Marañon
    Background The reliability of the recommended echocardiographic methods for assessing RV diastolic function has been questioned. We aimed to validate noninvasive indices of RV diastolic function, derived from tricuspid Doppler and myocardial deformation metrics, against intrinsic diastolic chamber properties and filling pressures. Methods We obtained simultaneous high-fidelity pressure-volume loops and echocardiographic data in separate animal and clinical settings: (1) a porcine model of acute hemodynamic interventions (n = 13), and (2) patients with Fallot tetralogy and pulmonary hypertension (n = 9). These designs allow for within- and between-subject validation. From the PV loops data, we obtained the reference values of RV stiffness (S+), elastic recoil (S−) and relaxation (τ) constants, as well as the contribution of passive properties to instantaneous diastolic pressures. Results In the animal setting, only the tricuspid E/A ratio and e’ velocity weakly correlated with S+ (Rrm:0.36 and 0.28 respectively, p < 0.01 for both). In the clinical group, no correlation was found between the echocardiographic indices and the intrinsic diastolic properties. Isovolumic relaxation time and early diastolic global strain-rate (GSR) correlated with mean right atrial pressure (RAP) (Spearman r: -0.73 and 0.85, respectively, p < 0.05 for both). E/e’ and E/GSR ratio were not associated with RAP. Tricuspid e’ and GSR negatively correlated with passive pressure component (only due to) at valve opening (Rrm -0.27 and − 0.33, respectively, p < 0.01 for both). Conclusions Recommended echocardiographic indices of RV diastolic function do not reflect intrinsic RV diastolic properties. Therefore, the application of these indices for inferring RV diastolic function and filling pressures is limited.
  • Miniatura
    Publicación
    Stasis imaging predicts the risk of cardioembolic events related to acute myocardial infarction: the ISBITAMI study
    (ELSEVIER, 2025) 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
    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).