Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries

Montone, Rocco Antonio; Niccoli, Giampaolo; Russo, Michele; Giaccari, Marta; Buono, Marco Giuseppe Del; Meucci, Maria Chiara; Gurguglione, Filippo L.; Vergallo, Rocco; D’Amario, Domenico; Buffon, Antonino; Leone, Antonio Maria; Burzotta, Francesco; Aurigemma, Cristina; Trani, Carlo; Liuzzo, Giovanna; Lanza, Gaetano Antonio; Crea, Filippo

doi:10.1007/s00392-019-01523-w

Cited by 47 publications

(33 citation statements)

References 37 publications

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“…The results of functional testing at the epicardial level were coupled with microcirculation interrogation in only 3 studies included in our review. Overall, microvascular dysfunction was found in one third of the 456 patients with MINOCA investigated by Montone et al [30], Pirozzolo et al [31], and Bil et al [32].…”

Section: Assessment In the Acute Phasementioning

confidence: 91%

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

Pelliccia

Pepine

Berry

et al. 2021

International Journal of Cardiology

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The role of cardiac magnetic resonance (CMR) in identifying mechanisms for myocardial infarction with nonobstructed coronary arteries (MINOCA) is well established. Recent reports have highlighted the potentially key role of invasive management in this diagnostic process. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) allow precise evaluation of coronary anatomy, and assessment of coronary physiology in the catheter laboratory provides information on the hemodynamic significance of sub-critical atherosclerosis and on coronary microvascular dysfunction (CMD). We reviewed the evidence for the contribution of invasive diagnostic techniques in identifying provisional causes for MINOCA. Overall, among 82 studies including 8457 patients were selected. In the acute phase, 16 studies with IVUS or OCT (1207 patients) disclosed that plaque disruption and spontaneous coronary artery dissection had a pooled prevalence of 38% (95% confidence intervals (CI): 29% to 51%) and 16% (95% CI: 9% to 27%), respectively. In 18 studies, coronary function testing (1449 patients) showed a pooled prevalence of spontaneous and/or provoked epicardial coronary spasm of~28% (95% CI:17% to 41%). In 3 studies (456 patients), the pooled prevalence of CMD was 32% (95% CI: 20% to 49%). In the subacute phase, 42 CMR studies (5821 patients) showed that a pooled prevalence of myocarditis, takotsubo syndrome and cardiomyopathy of 26% (95% CI: 12% to 40%), 11% (95% CI: 5% to 25%), and 7% (95% CI: 1% to 19%), respectively. In 12 studies on thrombophilia screening (n = 834), the pooled prevalence of thrombotic disorder was~11% (95% CI: 7%% to 25%). In conclusion, the pathophysiology of MINOCA can be established in the majority of cases using both invasive and non-invasive tools to provide direction for appropriate management.

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Section: Assessment In the Acute Phasementioning

confidence: 91%

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

Pelliccia

Pepine

Berry

et al. 2021

International Journal of Cardiology

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“…Coronary artery spasm represents the strong response to endogenous or exogenous vasoconstrictors of the vascular smooth muscle, which is one of the main causes of epicardial artery spasm in MINOCA. It has been found that 16–74% of patients with MINOCA show induced spasm, suggesting that coronary artery spasm is a common and essential pathogenesis of MINOCA [25-27]. Patients with coronary artery spasm may have angina pectoris at night or in the early morning, accompanied by short STE.…”

Section: Pathogenesis and Underlying Etiology Of Minocamentioning

confidence: 99%

“…Previous studies have shown that there is evidence of microcirculatory spasm in about 16% of MINOCA patients [28]. Two studies showed that 43–54% of MINOCA patients experienced microcirculatory spasm [25, 26]. The above symptoms can be reproduced by the intracoronary ACh test, triggering ischemic ECG changes (0.1 lower in ST-segment in at least 2 leads) without epicardial spasm (a diameter reduction >90%).…”

Section: Pathogenesis and Underlying Etiology Of Minocamentioning

confidence: 99%

“…A certain amount of ACh or ergometrine can be injected into the left and right coronary arteries for patients suspected of MINOCA, and the spasm of the coronary artery can be evaluated after 3 min by CAG. Several studies found that 43–54% of patients with MINOCA had coronary vasospasm, and it was recommended that all MINOCA patients have a coronary vasospasm provocation test [25, 26]. The diagnosis of acute pulmonary embolism should be considered in MINOCA, but the value of this diagnosis as a routine screening is not obvious.…”

Section: Clinical Assessment Of Minocamentioning

confidence: 99%

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Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

et al. 2020

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Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains a puzzling clinical entity that is characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis < 50%). Major advances in understanding this condition have been made in recent years. The precise pathogenesis is poorly understood and is being studied and examined further. Guidelines indicate that MINOCA is a group of heterogeneous diseases with different mechanisms of pathology. Since there are multiple possible pathological mechanisms, it is not certain that the classical secondary prevention and treatment strategy for MI with obstructive coronary artery disease (MI-CAD) is optimal for MINOCA patients. The prognosis and predictors for MINOCA patients remain unclear. Although the prognosis is slightly better for MINO-CA patients than for MI-CAD patients, MINOCA isn't always benign. The aim of this paper was to review the literature and evaluate MINOCA epidemiology, clinical features, etiology, diagnosis, treatment, and prognosis.

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“…(3) MINOCA es un síndrome clínico con múltiples causas que pueden afectar tanto los vasos epicárdicos como la microcirculación. A continuación veremos las siguientes causas etiológicas de este síndrome (25)(26)(27)(28)(29)(30)(31) 1. Etiología macrovascular-arterias epicárdicas:…”

Section: Etiopatogenia Y Características Clínicasunclassified

Ethiopathogenesis and prognostic implication in myocardial infarction without obstruction of the epicardial coronary arteries (MINOCA)

Martinez

Centurión

2020

Rev. virtual Soc. Parag. Med. Int

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Myocardial infarction without coronary artery obstruction (MINOCA) is a clinical syndrome characterized by clinical evidence of myocardial infarction with normal coronary arteries or with nonsignificant stenosis in coronary angiography equal to or less than 50%. MINOCA is a clinical syndrome with multiple etiologies that can affect both epicardial vessels and microcirculation, with a prevalence of 6%.

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Clinical, angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries

Cited by 47 publications

References 37 publications

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

The role of a comprehensive two-step diagnostic evaluation to unravel the pathophysiology of MINOCA: A review

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

Ethiopathogenesis and prognostic implication in myocardial infarction without obstruction of the epicardial coronary arteries (MINOCA)

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