Publications by authors named "Isabel Carvajal-Juarez"

10 Publications

  • Page 1 of 1

N-Ammonia myocardial blood flow quantitation in patient with aneurismal coronary artery disease.

J Nucl Cardiol 2021 May 6. Epub 2021 May 6.

Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, P.C 14080, Mexico City, Mexico.

Aneurysmal coronary artery disease includes coronary artery aneurysms and ectasia; this condition has been associated with poor long-term outcomes. Few studies have explored myocardial blood flow N-ammonia PET/CT MPI added value. We present a 45-year-old man who came to the emergency department with chest pain. After a physical examination and laboratory studies, he was diagnosed with very high-risk unstable angina and referred to the catheterization laboratory. Coronary angiography showed the culprit lesion in the LCx and was treated by angioplasty and stent. LAD was found with coronary artery ectasia (TIMI 2 flow grade) and the RCA with aneurysmal disease in the proximal and middle segments (TIMI 3 flow grade). Medical treatment was decided for these findings and the patient was discharged. Two weeks later, we performed a N-ammonia PET/CT MPI founding apical, inferior, and inferoseptal severe ischemia, and reduced hyperemic coronary blood flow and coronary flow reserve in the RCA territory. Flow was normal in the LAD territory. Although coronary angiography remains the gold standard for evaluating these coronary abnormalities, it does not show the physiological compromise. Therefore N-ammonia PET/CT MPI should be performed as a complementary noninvasive imaging approach.
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http://dx.doi.org/10.1007/s12350-021-02642-6DOI Listing
May 2021

Assessment of Atypical Cardiovascular Risk Factors Using Single Photon Emission Computed Tomography in Mexican Women.

Arch Med Res 2021 Apr 22. Epub 2021 Apr 22.

Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico; Department of Echocardiography, ABC Medical Center, I.A.P., Mexico City, Mexico. Electronic address:

Background: Ischemic heart disease (IHD) is a health care problem in women that increases morbimortality, particularly in developing countries. There is limited information regarding atypical risk factors associated with IHD in Mexican women.

Aim: To explore risk factors in women that could contribute to IHD and myocardial dysfunction using the single photon emission computed tomography (SPECT) myocardial perfusion study (MPS).

Methods: We designed a cross-sectional study in which we evaluated atypical and typical risk factors using a clinical questionnaire. We performed a SPECT-MPS to evaluate the presence of ischemia/infarction, decreased left ventricular ejection fraction, systolic dyssynchrony and diastolic function by peak filling rate and time to peak filling rate.

Results: 172 women were included, 64 with IHD. Adverse events during pregnancy (premature birth and miscarriage), rheumatoid arthritis, gynecological conditions (menopause and age of first menstruation) and low educational level, together with previously known typical risk factors were associated with infarction or ischemia and ventricular dysfunction. Potential associated factors for systolic dyssynchrony were rheumatoid arthritis (OR: 2.90, 95% CI: 0.95-8.66, p = 0.054) and history of premature birth (OR: 0.13, 95% CI: 0.01-0.66, p <0.01). Although those women with arterial hypertension and smoking shown an increased risk for dyssynchrony, these factors were not statistically significant. Low-educational level (OR 2.16, 95% CI 1.1-4.18, p = 0.019) was associated with decreased peak filling rate.

Conclusion: The presence of atypical risk factors in women could lead to decreased myocardial function, particularly in women at risk of developing IHD.
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http://dx.doi.org/10.1016/j.arcmed.2021.03.009DOI Listing
April 2021

[Colaboración de la Asociación Nacional de Cardiólogos de México y de la Sociedad Mexicana de Cardiología con la Universidad de Guanajuato. COVID-19 y personal de imagen cardiaca: Revisión de prácticas sanitarias al inicio de 2021].

Arch Cardiol Mex 2021 Mar 22. Epub 2021 Mar 22.

Servicio de Imagenología, Hospital Aranda de la Parra, León, Gto., México.

Los capítulos de imagen de la Asociación Nacional de Cardiólogos de México (ANCAM) y de la Sociedad Mexicana de Cardiología (SMC), así como personal del Departamento de Medicina y Nutrición de la Universidad de Guanajuato, en conjunto con destacados expertos de la imagen cardiovascular en México, han colaborado en la revisión, análisis y ampliación de las diversas estrategias sanitarias publicadas en los primeros 15 meses de la pandemia de enfermedad por coronavirus 2019 (COVID-19) para realizar con seguridad los estudios de imagen cardiaca; esta actualización tiene como objetivo principal disminuir el riesgo de transmisión de la COVID-19 entre los pacientes y el personal de salud en los servicios de tomografía, resonancia y cardiología nuclear. Este trabajo se amplió con información suplementaria disponible sin costo en el sitio www.ancam-imagen.com.
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http://dx.doi.org/10.24875/ACM.200003841DOI Listing
March 2021

Effectiveness and Safety of Extracorporeal Shockwave Myocardial Revascularization in Patients With Refractory Angina Pectoris and Heart Failure.

Am J Cardiol 2021 04 29;144:26-32. Epub 2020 Dec 29.

Immunology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico. Electronic address:

Extracorporeal shockwave myocardial revascularization (ESMR) is a therapy for refractory angina pectoris. Our aim was to assess the efficacy and safety of ESMR in the management of patients with stable coronary artery disease (CAD) and heart failure as well as its effects on inflammation and angiogenesis. In this single-arm prospective trial, we included 48 patients with CAD, myocardial ischemia assessed by radionuclide imaging, echocardiographic evidence of left ventricular systolic dysfunction and without revascularization options. Changes in angina grading score, myocardial perfusion, left ventricular ejection fraction, and six-minute walk test after ESMR therapy were used for efficacy assessment. Changes of inflammation and angiogenesis biomarkers were also evaluated. ESMR therapy was performed using a commercially available cardiac shockwave generator system (Cardiospec; Medispec). After 9 weeks of ESMR therapy, a significant improvement was found regarding the initial angina class, severity of ischemia, left ventricular ejection fraction, and six-minute walk test in most patients. No deleterious side effects after treatment were detected. Regarding biomarkers, endothelial progenitor cells and angiopoietin-3 were significantly increased whereas IL-18 and TGF-β were significantly decreased after ESMR in the total group. Notably, VEGF, IL-1ß, and lipoxin A4 levels were significantly increased only in patients with myocardial ischemia improvement. In conclusion, ESMR therapy is safe and effective in most but not all patients with CAD and heart failure. ESMR is associated with increased markers of angiogenesis and decreased markers of inflammation. Myocardial ischemia improvement after ESMR is associated with increased markers of angiogenesis and pro-resolving mediators.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.065DOI Listing
April 2021

Optimal Medical Treatment vs. Invasive Approach in Patients with Significantly Obstructive Coronary Artery Disease and Ischemia.

Arch Med Res 2020 07 20;51(5):413-418. Epub 2020 Apr 20.

Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología, Ciudad de México, México; Physiology Department, School of Medicine, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico. Electronic address:

Introduction: Stable ischemic heart disease (SIHD) is a condition that develops in subjects after myocardial infarction. Evidence suggests that optimal medical treatment (OMT) is not inferior to intervention (INT) using percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).

Aim: To compare clinical outcomes in subjects with SIHD who only received OMT and those who received INT+OMT.

Methods: We retrospectively examined subjects with SIHD who underwent myocardial perfusion study-SPECT/CT in a reference center in Mexico. We assigned two branches: INT+OMT (subjects with previous PCI or CABG) and OMT (subjects with antiplatelet drugs, β-blockers, renin-angiotensin-system blockade, nitrates, calcium-channel blockers, and aggressive lipid-lowering therapy). Clinical outcomes at follow-up were angina relief, functional class improvement, hospitalization, myocardial reinfarction and death from any cause.

Results: We included 100 subjects; 51 with OMT and 49 with INT+OMT. 54 subjects had 1 affected vessel and 46 more than 2. INT+OMT group had up to 14 fold likelihood (95% CI: 3.38-63.35) of achieving angina relief and 2.2 fold likelihood (95% CI: 0.92-5.57, p = 0.077) for functional class improvement. No differences were found in hospitalization, myocardial infarction and death from any cause compared to OMT.

Conclusions: Subjects with OMT have no higher risk of adverse clinical outcomes compared to INT+OMT. However, the INT+OMT provides angina relief and functional class improvement compared to OMT.
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http://dx.doi.org/10.1016/j.arcmed.2020.04.002DOI Listing
July 2020

Light-chain cardiac amyloidosis: A multimodality approach.

J Nucl Cardiol 2020 12 13;27(6):2432-2435. Epub 2020 Jan 13.

Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano N° 1, Colonia Sección XVI, Tlalpan, Mexico City, P.C 14080, Mexico.

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http://dx.doi.org/10.1007/s12350-019-02017-yDOI Listing
December 2020

Diastolic dyssynchrony assessment by gated myocardial perfusion-SPECT in subjects who underwent cardiac resynchronization therapy.

J Nucl Cardiol 2019 Aug 13. Epub 2019 Aug 13.

Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria.

Background: Left ventricular diastolic dyssynchrony (LVDD) can be assessed by gated myocardial perfusion single-photon emission computed tomography (GMP-SPECT). LVDD is an area of interest in subjects who underwent cardiac resynchronization therapy (CRT). The aim of this post hoc analysis was to assess the role of LVDD in subjects with CRT who were followed up at 6-month period.

Material & Methods: Left ventricular diastolic dyssynchrony was assessed by GMP-SPECT at baseline and after CRT procedure in 160 subjects from 10 different cardiological centers. CRT procedure was performed as per current guidelines. Outcomes were defined as improvement in ≥1 New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF) by 5%, and reduction in end-systolic volume (ESV) by 15% and 5% points in Minnesota Living with Heart Failure Questionnaire. LVDD was defined as diastolic phase standard deviation ≥40 ± 14°.

Results: Improvement in NYHA functional class occurred in 105 (65.6%), LVEF in 74 (46.3%), decrease in ESV in 86 (53.8%), and Minnesota score in 85 (53.1%) cases. Baseline LV diastolic standard deviation was 53.53° ± 20.85 and at follow-up 40.44° ± 26.1283; (P < 0.001). LVDD was not associated with improvement in clinical outcomes at follow-up.

Conclusion: CRT improves both systolic and diastolic dyssynchrony values at 6-month follow-up. LVDD at baseline is correlated with cardiac functionality at follow-up, but not with overall favorable clinical outcomes.
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http://dx.doi.org/10.1007/s12350-019-01845-2DOI Listing
August 2019

Comorbid conditions in individuals assessed by SPECT: Study of a reference cardiology center in Mexico City.

J Nucl Cardiol 2019 10 16;26(5):1617-1624. Epub 2019 May 16.

Nuclear Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1, Colonia Seccion XVI, Tlalpan, P. C. 14030, Mexico City, Mexico.

Background: There is an increasing prevalence of comorbidities in patients with ischemic heart disease (IHD) in developing countries. The aim of this work is to assess the prevalence of comorbidities and associated factors for IHD among patients at a reference cardiology center.

Design And Methods: This was a cross-sectional study. A complete clinical history which focused on the main comorbidities, previous myocardial infarction, and the main reason of referral was assessed. A single-photon emission computed tomography (SPECT) myocardial perfusion study (MPS) with two protocols was performed.

Results: We included 1998 patients, 64.2% male, median age 63 (I.R.: 56-71) years. 1514 (75.8%) subjects had at least one associated comorbidity. The main comorbidity was diabetes (T2D) (772: 38.6%), followed by systemic hypertension (737: 36.9%), smoking (518: 25.9%), and dyslipidemia (517: 25.9%). 806 (40.3%) had histories of previous myocardial infarctions. The main cause of referral was angina (923: 46.2%). We identified 1330 (66.5%) abnormal MPS. 460 (23%) had ischemia, 292 (14.6%) infarction, and 578 (28.9%) ischemia and infarction.

Conclusion: An increased prevalence of comorbidities was found in patients who were studied in the Nuclear Cardiology Department (NCD): most of them had traditional risk factors attributable to myocardial infarction. A great percentage were newly diagnosed with both ischemia and infarction.
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http://dx.doi.org/10.1007/s12350-019-01737-5DOI Listing
October 2019

Non-invasive assessment of endarteritis in Marfan syndrome with aortic dissection after surgical treatment.

J Nucl Cardiol 2019 Oct 9;26(5):1759-1760. Epub 2018 Aug 9.

Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Seccion XVI, Tlalpan, 14080, Mexico, Mexico.

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http://dx.doi.org/10.1007/s12350-018-1370-0DOI Listing
October 2019

Multimodality assessment of ventricular pseudoaneurysm after non-reperfused acute myocardial infarction.

J Nucl Cardiol 2019 Aug 24;26(4):1368-1372. Epub 2018 Jul 24.

Department of Nuclear Cardiology, Instituto Nacional de Cardiología Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Mexico.

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http://dx.doi.org/10.1007/s12350-018-1355-zDOI Listing
August 2019
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