Evolución de la imagen por resonancia magnética cardiacaaplicaciones clínicas y de investigación de la caracterización tisular en el infarto agudo de miocardio y la cardiotoxicidad

Zusammenfassung

Objectives: To determine the dynamics of the post-infarction edema curve by CMR at four time points during the first week after AMI (first hours post-perfusion, 1st, 4th, and 7th days). To determine the added value of CMR in the evaluation of systolic function in patients with cardiotoxicity and its potential recovery with treatment with sacubitril/valsartan. To transfer the preclinical data observed about the presence of myocardial edema identified by RMC in an animal model to humans, for the early detection of cardiotoxicity. Conclusion: CMR and new T2 parametric mapping sequences allow the identification of myocardial edema, which plays a major role in the acute ischemic heart disease and cardiotoxicity. Myocardial edema in the first week post-infarction follows a dynamic bimodal pattern, and its extension therefore varies depending on when the CMR study is acquired. Its quantification directly affects the estimation of the area at risk and suggests that a standardization of the protocols for the acquisition of CMR studies which aim to delimit the myocardium at risk and saved myocardium is necessary. Based on published data, a time window between days 4 and 7 after reperfusion seems reasonable. Treatment with sacubitril/valsartan seems to be effective in recovering parameters of systolic function and functional recovery in patients with heart failure due to cardiotoxicity. The edema identified by RMC mapping sequences is an early marker of cardiotoxicity in patients receiving anthracyclines. Detection of these changes at a reversible stage of myocardial damage demonstrates the clinical potential of this CMR marker for the individualized treatment of patients with cardiotoxicity.