Rodríguez González, ElenaMartínez-Legazpi Aguilo, PabloMombiela, TeresaGonzález Mansilla, AnaDelgado Montero, AntoniaGuzmán-De-Villoria, Juan A.Díaz Otero, FernandoPrieto Arévalo, RaquelJuárez, MiriamGarcía del Rey, María del CarmenFernández-García, PilarFlores, ÓscarPostigo, AndreaYotti, RaquelGarcía Villalba, ManuelFernández Avilés, FranciscoÁlamo, Juan C. delBermejo, Javier2025-02-052025-02-052025Elena 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, Stasis imaging predicts the risk of cardioembolic events related to acute myocardial infarction: the ISBITAMI study, Revista Española de Cardiología (English Edition), Volume 78, Issue 1, 2025, Pages 22-33, ISSN 1885-5857, https://doi.org/10.1016/j.rec.2024.04.0071885-5857https://doi.org/10.1016/j.rec.2024.04.007https://hdl.handle.net/20.500.14468/25824The registered version of this article, first published in “Revista Española de Cardiología (English Edition)2025", is available online at the publisher's website: Elsevier, https://doi.org/10.1016/j.rec.2024.04.007 La versión registrada de este artículo, publicado por primera vez en “Revista Española de Cardiología (English Edition)2025", está disponible en línea en el sitio web del editor: Elsevier, https://doi.org/10.1016/j.rec.2024.04.007Introduction 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).eninfo:eu-repo/semantics/openAccess23 Química::2302 Bioquímica ::2302.26 Bioquímica físicaartículoischemic strokeST-segment elevation myocardial infarctionechocardiographyblood stasiscardioembolism