Anais Hausvater1, Sivabaskari Pasupathy2, Per Tornvall3, Himali Gandhi4, Rosanna Tavella2, John Beltrame2, Stefan Agewall5, Christina Ekenbäck6, Elin Bacsovics Brolin7, Judith S Hochman1, Olov Collste3, Harmony R Reynolds8. 1. Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, United States of America. 2. Discipline of Medicine, University of Adelaide, Cardiology Department, Central Adelaide Local Health Network, Adelaide, Australia. 3. Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 4. Department of Medicine, Montefiore Medical Center, Bronx, NY, United States of America. 5. Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 6. Department of Clinical Sciences, Danderyd Hospital Stockholm, Sweden. 7. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. 8. Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, United States of America. Electronic address: harmony.reynolds@nyumc.org.
Abstract
PURPOSE: Patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) may present with or without ST-elevation (STE) on the electrocardiogram (ECG). Previous studies have shown that STE was associated with higher risk of early mortality and long-term major adverse coronary events, and that cardiac magnetic resonance imaging (CMR) can help to determine whether the cause of a MINOCA presentation is ischemic or non-ischemic. We set out to determine the relationship between STE and CMR findings in patients presenting with MINOCA. DESIGN: Patients who underwent CMR based on a provisional diagnosis of MINOCA were pooled from three prospective cohort studies: the multicenter Stockholm Myocardial Infarction with Normal Coronaries, a prospective University of Adelaide study, and a prospective NYU School of Medicine diagnostic imaging study. STE was defined as ≥1 mm in ≥2 contiguous leads. RESULTS: Among 292 patients, average age was 57.0 years (±11.9), and 68% were female. Fifty-seven had STE, 231 had no STE and four had left bundle branch block. There was no difference between patients with vs. without STE in the likelihood of the CMR findings of infarction (21% vs. 18%), myocarditis (10% vs. 14%), left ventricular wall motion pattern consistent with takotsubo syndrome on CMR (16% vs. 14%). CONCLUSION: STE on the presenting ECG was not associated with CMR findings in patients with a provisional diagnosis of MINOCA. Based on these findings, increased risk among MINOCA patients with STE does not appear to be related to variation in these CMR findings.
PURPOSE:Patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) may present with or without ST-elevation (STE) on the electrocardiogram (ECG). Previous studies have shown that STE was associated with higher risk of early mortality and long-term major adverse coronary events, and that cardiac magnetic resonance imaging (CMR) can help to determine whether the cause of a MINOCA presentation is ischemic or non-ischemic. We set out to determine the relationship between STE and CMR findings in patients presenting with MINOCA. DESIGN:Patients who underwent CMR based on a provisional diagnosis of MINOCA were pooled from three prospective cohort studies: the multicenter Stockholm Myocardial Infarction with Normal Coronaries, a prospective University of Adelaide study, and a prospective NYU School of Medicine diagnostic imaging study. STE was defined as ≥1 mm in ≥2 contiguous leads. RESULTS: Among 292 patients, average age was 57.0 years (±11.9), and 68% were female. Fifty-seven had STE, 231 had no STE and four had left bundle branch block. There was no difference between patients with vs. without STE in the likelihood of the CMR findings of infarction (21% vs. 18%), myocarditis (10% vs. 14%), left ventricular wall motion pattern consistent with takotsubo syndrome on CMR (16% vs. 14%). CONCLUSION: STE on the presenting ECG was not associated with CMR findings in patients with a provisional diagnosis of MINOCA. Based on these findings, increased risk among MINOCA patients with STE does not appear to be related to variation in these CMR findings.
Authors: Anaïs Hausvater; Nathaniel R Smilowitz; Boyangzi Li; Gabriel Redel-Traub; Mary Quien; Yingzhi Qian; Judy Zhong; Joseph M Nicholson; Giovanni Camastra; Loïc Bière; Roman Panovský; Montenegro Sá; Edouard Gerbaud; Joseph B Selvanayagam; Mouaz H Al-Mallah; Tilman Emrich; Harmony R Reynolds Journal: JACC Cardiovasc Imaging Date: 2020-07-09