Study identifies subgroup of heart attack patients

Val d’Hebron took part in a study that concluded that patients with acute myocardial infarction who have some degree of necrosis (tissue death) in the papillary muscles of the left ventricle, detected by cardiac magnetic resonance (CMR), have greater probability of death. , the appearance of arrhythmias and long-term heart failure.

The results of this study, conducted by Dr. Robin Neuveldt from the Radboud University Hospital in Nijmegen (Netherlands), were recently published in the journal JACC Cardiovascular Imaging. It was attended by doctors Vicente Bodi, Head of the Department of Cardiology Services at the University Hospital of Valencia, Coordinator of the Translational Research Group on Ischemic Cardiopathy INCLIVA and Researcher at the Network Biomedical Research Center for Cardiovascular Diseases (CIBERCV). Carlos III Health Institute; José Gavara from the Center for Biomaterials and Tissue Engineering of the Polytechnic University of Valencia (UPV); and doctors José Fernando Rodríguez-Palomares from the Hospital Vall d’Hebron in Barcelona and CIBERCV, and José Ortiz from the Hospital Clínic in Barcelona.

Coronary heart disease includes a complex of pathologies characterized by insufficient oxygen supply to the heart compared to needs. In particular, acute myocardial infarction is a sudden occlusion of a coronary artery, usually due to a blood clot, and is a pathology commonly encountered in Western countries. After a heart attack, 15–40% of patients experience necrosis of the papillary muscles of the left ventricle of the heart to varying degrees. In the short term (1 year), the presence of necrosis in this area was associated with an increased incidence of adverse cardiovascular events such as death or heart failure. However, it is unclear whether this negative effect will persist in the long term, and the mechanisms leading to this frequency of events have not been determined.

The above-mentioned multicenter study included 1055 patients with first acute myocardial infarction from the University Teaching Hospital of Valencia and Hospitals Clínica and Vall d’Hebron in Barcelona, ​​based on a joint registry of three hospitals over more than 5 years.

These patients underwent cardiac magnetic resonance imaging one week after infarction, and their clinical development was followed for an average of 6.5 ± 4.4 years.

The use of magnetic resonance imaging, the modality of choice for assessing cardiac damage after a heart attack, has been critical in identifying and characterizing the extent of papillary muscle damage. In 351 patients (33%), necrosis was observed in the papillary muscles (manifested by a zone of contrast retention in these muscles, in the area of ​​attachment of the mitral valve to the walls of the left ventricle). ). Patients in whom this sign was detected had more depressed contractile function and a larger infarct size in the left ventricle. Likewise, the presence of papillary muscle damage was associated with higher rates of cardiovascular mortality and heart failure. Interestingly, a higher incidence of serious arrhythmias was found in patients who were found to have this feature.

This project was funded thanks to the Carlos III Institute of Health, CIBERCV, the Regional Development Fund (FEDER) and the Generalitat of Valencia through the PROMETEO program for advanced research groups in the Valencian Community.