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Themudo, Raquel
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Publications (9 of 9) Show all publications
Themudo, R., Johansson, L. E., Ebeling Barbier, C., Lind, L., Ahlström, H. & Bjerner, T. (2017). The number of unrecognized myocardial infarction scars detected at DE-MRI increase during a 5-year follow-up. European Radiology, 27(2), 715-722
Open this publication in new window or tab >>The number of unrecognized myocardial infarction scars detected at DE-MRI increase during a 5-year follow-up
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2017 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 27, no 2, p. 715-722Article in journal (Refereed) Published
Abstract [en]

Objectives

In an elderly population, the prevalence of unrecognized myocardial infarction (UMI) scars found via late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging was more frequent than expected. This study investigated whether UMI scars detected with LGE-CMR at age 70 would be detectable at age 75 and whether the scar size changed over time.

Methods

From 248 participants that underwent LGE-CMR at age 70, 185 subjects underwent a follow-up scan at age 75. A myocardial infarction (MI) scar was defined as late enhancement involving the subendocardium.

Results

In the 185 subjects that underwent follow-up, 42 subjects had a UMI scar at age 70 and 61 subjects had a UMI scar at age 75. Thirty-seven (88 %) of the 42 UMI scars seen at age 70 were seen in the same myocardial segment at age 75. The size of UMI scars did not differ between age 70 and 75.

Conclusions

The prevalence of UMI scars detected at LGE-CMR increases with age. During a 5-year follow-up, 88 % (37/42) of the UMI scars were visible in the same myocardial segment, reassuring that UMI scars are a consistent finding. The size of UMI scars detected during LGE-CMR did not change over time.

Keywords
Unrecognized myocardial infarction, delayed-enhancement magnetic resonance imaging, follow-up study, epidemiology
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems
Research subject
Radiology; Cardiology; Epidemiology
Identifiers
urn:nbn:se:uu:diva-172069 (URN)10.1007/s00330-016-4439-7 (DOI)000392142000032 ()27255402 (PubMedID)
Funder
Swedish Research Council, k2013-64x-08268-3
Available from: 2012-04-02 Created: 2012-04-02 Last updated: 2017-12-07Bibliographically approved
Ebeling Barbier, C., Themudo, R., Bjerner, T., Johansson, L., Lind, L. & Ahlström, H. (2016). Long-term prognosis of unrecognized myocardial infarction detected with cardiovascular magnetic resonance in an elderly population. Journal of Cardiovascular Magnetic Resonance, 18(1), 43
Open this publication in new window or tab >>Long-term prognosis of unrecognized myocardial infarction detected with cardiovascular magnetic resonance in an elderly population
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2016 (English)In: Journal of Cardiovascular Magnetic Resonance, ISSN 1097-6647, E-ISSN 1532-429X, Vol. 18, no 1, p. 43-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Individuals with unrecognized myocardial infarctions (UMIs) detected with cardiovascular magnetic resonance (CMR) constitute a recently defined group whose prognosis has not been fully evaluated. However, increasing evidence indicate that these individuals may be at considerable cardiovascular risk. The aim of the present study was to investigate the prognostic impact of CMR detected UMIs for major adverse cardiac events (MACE) in community living elderly individuals.

METHODS: Late gadolinium enhancement CMR was performed in 248 randomly chosen 70-year-olds. Individuals with myocardial infarction (MI) scars, with or without a hospital diagnosis of MI were classified as recognized MI (RMI) or UMI, respectively. Medical records and death certificates were scrutinized. MACE was defined as cardiac death, non-fatal MI, a new diagnosis of angina pectoris, or symptom-driven coronary artery revascularization.

RESULTS: During follow-up (mean 11 years) MACE occurred in 10 % (n = 18/182) of the individuals without MI scars, in 20 % (n = 11/55) of the individuals with UMI, and in 45 % (n = 5/11) of the individuals with RMI, with a significant difference between the UMI group and the group without MI scars (p = 0.045), and between the RMI group and the group without MI scars (p = 0.0004). Cardiac death and/or non-fatal MI occurred in 15, 5, and 3 of the individuals in the NoMI, UMI, and RMI group respectively. Hazards ratios for MACE adjusted for risk factors and sex were 2.55 (95 % CI 1.20-5.42; p = 0.015) for UMI and 3.28 (95 % CI1.16-9.22; p = 0.025) for RMI.

CONCLUSIONS: The presence of a CMR detected UMI entailed a more than double risk for MACE in community living 70-year-old individuals.

Keywords
Unrecognized myocardial infarction; Cardiovascular magnetic resonance; Epidemiology; Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-300406 (URN)10.1186/s12968-016-0264-z (DOI)000381378600001 ()27430315 (PubMedID)
Funder
Swedish Research Council, K2013-64X-08268-23-3
Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2018-02-28Bibliographically approved
Ebeling Barbier, C., Themudo, R., Bjerner, T., Johansson, L., Lindahl, B., Venge, P., . . . Ahlström, H. (2014). Cardiac Troponin I Associated with the Development of Unrecognized Myocardial Infarctions Detected with MRI. Clinical Chemistry, 60(10), 1327-1335
Open this publication in new window or tab >>Cardiac Troponin I Associated with the Development of Unrecognized Myocardial Infarctions Detected with MRI
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2014 (English)In: Clinical Chemistry, ISSN 0009-9147, E-ISSN 1530-8561, Vol. 60, no 10, p. 1327-1335Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Late enhancement MRI (LE-MRI) and cardiac troponin I (cTnI) are sensitive methods to detect subclinical myocardial injury. We sought to investigate the relation between plasma concentrations of cTnI measured with a high-sensitivity assay (hs-cTnI) and the development of unrecognized myocardial infarctions (UMIs) detected with LE-MRI.

METHODS:

After approval from the ethics committee and written informed consent were obtained, LE-MRI was performed on 248 randomly selected community-living 70-year-old volunteers and hs-cTnI was determined with a highly sensitive premarket assay. Five years later these individuals were invited to a second LE-MRI, and 176 of them (82 women, 94 men), who did not have a hospital diagnosis of MI, constitute the present study population. LE-MR images were analyzed by 2 radiologists independently and in a consensus reading, blinded to any information on previous disease or assessments.

RESULTS:

New or larger UMIs were detected in 37 participants during follow-up. Plasma concentrations of hs-cTnI at 70 years of age, which were mainly within what is considered to be the reference interval, were related to new or larger UMIs at 75 years of age with an odds ratio of 1.98 per 1 unit increase in ln-transformed cTnI (95% CI, 1.17-3.35; P = 0.010). Plasma concentrations of hs-cTnI at 70 years of age were associated with the volumes of the UMIs detected at 75 years of age (P = 0.028).

CONCLUSIONS:

hs-cTnI in 70-year-old community-living women and men was associated with the development of MRI-detected UMIs within 5 years.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-230027 (URN)10.1373/clinchem.2014.222430 (DOI)000344779700016 ()25062810 (PubMedID)
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2017-12-05Bibliographically approved
Espregueira Themudo, R. (2012). Clinically Unrecognized Myocardial Scars Detected by MRI. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Clinically Unrecognized Myocardial Scars Detected by MRI
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A high percentage of unrecognized myocardial infarctions (UMIs) seen at delayed-enhanced magnetic resonance imaging (DE-MRI) are not detected by ECG. DE-MRI-detected UMIs are independent predictors of cardiovascular events in patients with coronary artery disease. In an elderly population, subjects with DE-MRI-detected UMIs do not have increased Framingham risk score or increased prevalence of artery stenosis in whole-body MR angiography as patients with recognized myocardial infarctions (RMI). Further investigation on the pathogenesis of DE-MRI-detected UMIs focus on the need to decide the management of these subjects.

From the Prospective Investigation of the Vasculature in Uppsala Seniors, 248 subjects underwent cardiac MRI at age 70 and from these, 185 underwent a 5-year follow-up MR. DE-MRI-detected UMIs had lower signal intensity than RMIs probably reflecting different composition of their tissues. Subjects with UMI scar had increased levels of NT-proBNP, a predictor of increased risk of cardiovascular events. After 5 years, UMI scars were in their majority seen on the same location and with the same size, and their prevalence increased. Subjects with an UMI did not differ from subjects without a scar in terms of coronary stenosis assessed by computed tomography angiography or signs of ischemia on exercise test.

In conclusion, DE-MRI-detected UMI scars are a frequent finding in an elderly population and its prevalence increases with age. The increased levels of NT-proBNP indicate that subjects with an UMI might have an increased rate of future cardiovascular events but the findings that these scars might have a different contrast distribution volume on MRI and that they are not related to CAD are indicators that they probably have a different etiology from RMIs. The prognosis of DE-MRI detected UMI scars in the general population is still unknown and therefore the clinical management of these individuals is yet to be defined.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. p. ??
Keywords
unrecognized myocardial scars, myocardial infarction, epidemiology, magnetic resonance, computed topographic coronary angiography, exercise test, NT-proBNP
National Category
Radiology, Nuclear Medicine and Medical Imaging Cardiac and Cardiovascular Systems
Research subject
Radiology; Cardiology
Identifiers
urn:nbn:se:uu:diva-172017 (URN)978-91-506-2283-6 (ISBN)
Public defence
2012-05-21, Grönwallsalen, Akademiska Sjukhuset, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2012-04-26 Created: 2012-04-01 Last updated: 2012-04-26Bibliographically approved
Canto Moreira, N., Teixeira, J., Themudo, R., Amini, H., Axelsson, O., Raininko, R. & Wikström, J. (2011). Measurements of the normal fetal brain at gestation weeks 17 to 23: a MRI study. Neuroradiology, 53(1), 43-48
Open this publication in new window or tab >>Measurements of the normal fetal brain at gestation weeks 17 to 23: a MRI study
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2011 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 53, no 1, p. 43-48Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: To obtain measurements of the normal fetal brain before 24 weeks of gestation (GW), a deadline for medical decisions on fetal viability in a large number of countries. METHODS: We retrospectively reviewed 70 normal MR examinations of fetuses aged GW 17 to 23. The fronto-occipital diameter, the cerebral bi-parietal diameter, the transverse cerebellar diameter, the vermian height, and antero-posterior diameter were measured. RESULTS: The median, maximum, and minimum values for each parameter were displayed for each individual GW. CONCLUSION: The recorded data might contribute to a better assessment of fetal health by providing normal boundaries for the brain growth.

Keywords
Biometry, Brain, Fetal, MRI, Normal development
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-132616 (URN)10.1007/s00234-010-0772-8 (DOI)000285878200008 ()20878397 (PubMedID)
Available from: 2010-10-22 Created: 2010-10-22 Last updated: 2017-12-12Bibliographically approved
Ebeling Barbier, C., Nylander, R., Themudo, R., Ahlström, H., Lind, L., Larsson, E.-M., . . . Johansson, L. (2011). Prevalence of unrecognized myocardial infarction detected with magnetic resonance imaging and its relationship to cerebral ischemic lesions in both sexes. Journal of the American College of Cardiology, 58(13), 1372-1377
Open this publication in new window or tab >>Prevalence of unrecognized myocardial infarction detected with magnetic resonance imaging and its relationship to cerebral ischemic lesions in both sexes
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2011 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 58, no 13, p. 1372-1377Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The purpose of this study was to investigate the prevalence of unrecognized myocardial infarction (UMI) detected with magnetic resonance imaging (MRI) and whether it is related to cerebral ischemic lesions on MRI in an elderly population-based cohort.

BACKGROUND: There is a correlation between stroke and recognized myocardial infarction (RMI) and between stroke and UMI detected with electrocardiography, whereas the prevalence of stroke in subjects with MRI-detected UMI is unknown.

METHODS: Cerebral MRI and cardiac late-enhancement MRI were performed on 394 randomly selected 75-year-old subjects (188 women, 206 men). Images were assessed for cerebral ischemic lesions and myocardial infarction (MI) scars. Medical records were scrutinized. Subjects with MI scars, with or without a hospital diagnosis of MI, were classified as RMI or UMI, respectively.

RESULTS: UMIs were found in 120 subjects (30%) and RMIs in 21 (5%). The prevalence of UMIs (p = 0.004) and RMIs (p = 0.02) was greater in men than in women. Men with RMI displayed an increased prevalence of cortical and lacunar cerebral infarctions, whereas women with UMI more frequently had cortical cerebral infarctions (p = 0.003).

CONCLUSIONS: MI scars are more frequent in men than in women at 75 years of age. The prevalence of RMI is related to that of cerebral infarctions.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-160996 (URN)10.1016/j.jacc.2011.06.028 (DOI)21920267 (PubMedID)
Available from: 2011-11-04 Created: 2011-11-04 Last updated: 2017-12-08Bibliographically approved
Themudo, R. E., Lindahl, B., Johansson, L., Venge, P., Ahlström, H., Ebeling Barbier, C., . . . Bjerner, T. (2011). Unrecognized myocardial scars detected by delayed-enhanced MRI are associated with increased levels of NT-proBNP. Coronary Artery Disease, 22(3), 158-164
Open this publication in new window or tab >>Unrecognized myocardial scars detected by delayed-enhanced MRI are associated with increased levels of NT-proBNP
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2011 (English)In: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 22, no 3, p. 158-164Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Patients with unrecognized myocardial infarction (UMI) scars detected by delayed-enhanced magnetic resonance imaging (DE-MRI) have a decreased left ventricular ejection fraction and an increased left ventricular mass. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of heart failure, and troponin I (TnI) is a marker of myocardial injury. The primary aim of this study was to investigate whether NT-proBNP plasma levels (in addition to ejection fraction) differed in patients with UMI scars compared with normal participants. The second aim was to compare whether the TnI levels differed in those two groups. METHODS: Data from the Prospective Investigation of Vasculature in Uppsala Seniors study were used. The participants who had undergone cardiac MRI were included in this study (n=248). Patients were divided into three groups depending on the existence of a myocardial infarction (MI) scar in DE-MRI and their earlier history of MI. In all the patients, a peripheral blood sample was collected and the plasma levels of NT-proBNP and TnI were determined. RESULTS: Patients with UMI had higher plasma levels of NT-proBNP (median 140.2 ng/l; 25th-75th percentiles: 79-225.5) than no-MI participants (median 94.9 ng/l; 25th-75th percentiles: 59.2-144.2; P=0.01) and lower levels than patients with recognized MI (median 310.4 ng/l; 25th-75th percentiles: 122.6-446.5; P=0.02). Plasma TnI values did not differ among the three groups. CONCLUSION: Patients with UMI scars detected by DE-MRI have increased plasma levels of NT-proBNP that is known to correlate with an increased risk of future cardiovascular adverse events.

Keywords
epidemiology, infarction, prognosis, silent, troponin I, viability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-141510 (URN)10.1097/MCA.0b013e328342c72e (DOI)000289506000006 ()21200318 (PubMedID)
Available from: 2011-01-12 Created: 2011-01-12 Last updated: 2017-12-11Bibliographically approved
Themudo, R. E., Johansson, L., Ebeling Barbier, C., Lind, L., Ahlström, H. & Bjerner, T. (2009). Signal Intensity of Myocardial Scars at Delayed-enhanced MRI. Acta Radiologica, 50(6), 652-7
Open this publication in new window or tab >>Signal Intensity of Myocardial Scars at Delayed-enhanced MRI
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2009 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 50, no 6, p. 652-7Article in journal (Refereed) Published
Abstract [en]

Background: Traditionally, unrecognized myocardial infarction (UMI) is defined as the appearance, in a non-acute setting, of a new diagnostic Q wave. In the recent past, delayed-enhanced magnetic resonance imaging (DE-MRI) has provided a new imaging method for evaluating myocardial viability and to detect myocardial scars. Purpose: To investigate differences in tissue characteristics between UMI and recognized myocardial infarction (RMI) scars, by assessing the signal intensity (SI) detected by DE-MRI. Material and Methods: A randomized subgroup of 259 subjects from the Prospective Investigation of the Vasculature of Uppsala Seniors (PIVUS) study was submitted to cardiac magnetic resonance imaging (MRI). DE-MRI-detected myocardial scars were divided in two groups, UMI and RMI, according to the hospital medical records. The scars detected by DE-MRI were analyzed by measuring SI ratio of scar tissue to normal myocardium. Results: The mean SI ratio in the UMI group (4.5+/-3.0, mean+/-SD) was lower than in the RMI group 8.9+/-5.1 (P-value = 0.001). This difference was still significant (P <0.0001) after adjustment for gender, body mass index, time of image acquisition after gadolinium administration, scar transmurality, or total myocardial infarction mass. Conclusion: The difference in the SI ratio of the scars between the two groups most likely reflects a different contrast distribution volume of the tissues, which might indicate that UMI and RMI tissues diverge in tissue composition.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-103590 (URN)10.1080/02841850902933081 (DOI)000267256400011 ()19449231 (PubMedID)
Available from: 2009-05-20 Created: 2009-05-20 Last updated: 2017-12-13Bibliographically approved
Wanhainen, A., Themudo, R., Ahlström, H., Lind, L. & Johansson, L. (2008). Thoracic and abdominal aortic dimension in 70-year-old men and women: a population-based whole-body magnetic resonance imaging (MRI) study. Journal of Vascular Surgery, 47(3), 504-12
Open this publication in new window or tab >>Thoracic and abdominal aortic dimension in 70-year-old men and women: a population-based whole-body magnetic resonance imaging (MRI) study
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2008 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 47, no 3, p. 504-12Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this population-based study was to determine the optimal dividing-line between normal aorta and aneurysm for different aortic segments in 70-year-old men and women by means of whole-body magnetic resonance imaging. METHODS: Two hundred thirty-one subjects (116 men), randomly recruited from a population-based cohort study, were included. The smallest outer diameter (dia) was measured on the axial survey scan on six predefined aortic segments: (1) ascending aorta, (2) descending aorta, (3) supraceliac aorta, (4) suprarenal aorta, (5) largest infrarenal abdominal aorta, and (6) aortic bifurcation. Relative aortic dia were calculated by dividing a given aortic dia by the suprarenal aortic dia. The dividing-line between normal aorta and aneurysm at different aortic segments was estimated by taking the mean dia +2 SD and/or mean ratio of the aortic segment to the suprarenal aorta +2 SD. RESULTS: The mean dia of the six segments were 4.0 cm (SD 0.4), 3.2 cm (0.3), 3.0 cm (0.3), 2.8 cm (0.3), 2.4 cm (0.5), and 2.3 cm (0.3) in men. The corresponding dia in women were 3.4 cm (0.4), 2.8 cm (0.3), 2.7 cm (0.3), 2.7 cm (0.3), 2.2 cm (0.3), and 2.0 cm (0.2). The mean ratio to the suprarenal aorta was 1.4 (SD 0.2) for the ascending aorta, 1.2 (0.1) for the descending aorta, and 0.9 (0.2) for the infrarenal aorta in men. The corresponding ratios in women were 1.3 (0.2), 1.0 (0.1), and 0.8 (0.1). CONCLUSION: For men the suggested dividing-line (dia and ratio) between normal aorta and aneurysm for the ascending aorta is 4.7 cm dia and 1.8 ratio, for the descending aorta 3.7 cm dia and 1.5 ratio, and for the infrarenal aorta is 3.0 cm dia and 1.1 ratio. The corresponding dividing-lines for women are 4.2 cm dia and 1.7 ratio, 3.3 cm dia and 1.3 ratio, and 2.7 cm dia and 1.0 ratio.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-88028 (URN)10.1016/j.jvs.2007.10.043 (DOI)000253428700004 ()18207354 (PubMedID)
Available from: 2009-01-19 Created: 2009-01-19 Last updated: 2017-12-14Bibliographically approved
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