Myocardial infarction with non-obstructive coronary arteries (MINOCA): Intracoronary imaging-based diagnosis and management

Sucato, Vincenzo; Testa, Gabriella; Puglisi, S.; Evola, Salvatore; Galassi, Alfredo R.; Novo, Giuseppina

doi:10.1016/j.jjcc.2021.01.001

Cited by 35 publications

(31 citation statements)

References 60 publications

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“…It has been proposed that the onset of angina in patients with non-obstructive CAD might be caused by non-ischemic mechanisms, such as neurogenic and behavioral disorders, which cause an increased adrenergic activity and/or abnormal function of sympathetic and nociceptive nerve fibers of the heart, leading to an enhanced pain perception to harmless local stimuli. 4,5 It is also possible that estrogen deficiency in women with MVA contributes to altered chest pain perception. 6 However, the main mechanism which leads to myocardial ischemia in patients with MVA is coronary microvascular dysfunction (CMD), defined as alterations involving the structure or vasoreactivity of the coronary microcirculation.…”

Section: Introductionmentioning

confidence: 99%

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

et al. 2021

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The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have investigated the possible relationships between blood biomarkers involved with CMD and MVA. More specifically, we have divided the analyzed biomarkers into 3 different groups, according to the main mechanisms underlying CMD: biomarkers of “endothelial dysfunction,” “vascular inflammation,” and “oxidative stress.” Finally, in the last section of the review, we consider mixed mechanisms and biomarkers which are not included in the 3 major categories mentioned above, but could be involved in the pathogenesis of CMD.

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Section: Introductionmentioning

confidence: 99%

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

et al. 2021

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“…В последние годы среди лиц, направляемых на инвазивную коронароангиографию (КАГ), все чаще фиксируются случаи необструктивного поражения КА (НПКА). Так, наличие интактных КА или НПКА имеет место у 40% больных с подозрением на ИБС и у 25% -с ОКСбпST [2]. По данным ряда исследований в Российской Федерации при ежегодном увеличении числа КАГ примерно у 50% пациентов данная процедура не заканчивается реваскуляризацией миокарда, в большинстве случаев из-за отсутствия обструктивного поражения КА (ОПКА) [3].…”

Section: Electrocardiographic Echocardiographic and Lipid Parameters ...unclassified

“…Их наибольшие значения ассоциировались с уровнем ХС ЛВП (-3,9; p=0,0007), КСО (3,8; p=0,004) и КСИ (3,34; p=0,005). Меньшими по величине, но сопоставимыми по уровню значимости были показатели ИГФ (-2,59), КДО (2,32), КДИ (2,24), ГПСД ЛЖ (2,17), ХС ЛНП (2,1), ОХС (1,9), КДР (1,71), ИММЛЖ (1,7), ИИР (1,6), ФВ ЛЖ (-1,45), мужской пол (0,9). При этом весовые коэффициенты таких факторов, как ТГ и элевация ST aVR , были статистически недостоверными.…”

Section: материал и методыunclassified

Electrocardiographic, echocardiographic and lipid parameters in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

et al. 2022

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Aim. To assess the predictive potential of electrocardiographic (ECG), echocardiographic, and lipid parameters for predicting obstructive coronary artery disease (oCAD) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) prior to invasive coronary angiography (CA).Material and methods. This prospective observational cohort study included 525 patients with NSTE-ACS with a median age of 62 years who underwent invasive coronary angiography. Two groups were distinguished, the first of which consisted of 351 (67%) patients with oCAD (stenosis 50%), and the second — 174 (33%) without oCAD (<50%). Clinical and functional status of patients before CAG was assessed by 40 indicators. Mann-Whitney, Fisher, chi-squared, univariate logistic regression (LR) methods were used for data processing and analysis, while miltivariate LR (MLR), gradient boosting (XGBoost) and artificial neural networks (ANN) were used to develop predictive models. The quality of the models was assessed using 4 following metrics: area under the ROC curve (AUC), sensitivity (Se), specificity (Sp), and accuracy (Ac).Results. A comprehensive analysis of ECG, echocardiography and lipid profile parameters made it possible to identify factors that had linear and non-linear association with oCAD. LR were used to determine their weight coefficients and threshold values with the highest predictive potential. The quality metrics of the best predictive algorithm based on MLR were 0,81 for AUC, 0,74 for Sp and Ac, and 0,75 for Se. The predictors of this model were 4 categorical parameters (left ventricular (LV) ejection fraction of 42-60%, global LV longitudinal systolic strain <19%, low-density lipoprotein cholesterol >3,5 mmol/l, age >55 years in men and >65 years for women).Conclusion. The prognostic model developed on the basis of MLR made it possible to verify oCAD with high accuracy in patients with NSTE-ACS before invasive CA. Models based on XGBoost and ANN had less predictive value.

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“… [8] Imaging studies to assess MINOCA include coronary angiography with or without intravascular ultrasound or optical coherence tomography, as well as possibly intracoronary acetylcholine if coronary spasm is suspected. [ 9 , 8 , 10 ] Yet other cardiac imaging studies to help assess MINOCA include echocardiography, [10] with PET and CMR useful to assess coronary microvascular dysfunction. [ 11 , 12 ] Most instances of coronary artery disease involve macrovascular disease leading to obstruction and often clinically manifest by angina and myocardial infarction.…”

Section: Appropriate Use [ 4 5 ]mentioning

confidence: 99%

Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

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Khera

Blaha³

et al. 2021

American Journal of Preventive Cardiology

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Knowing the patient's current cardiovascular disease (CVD) status, as well as the patient's current and future CVD risk, helps the clinician make more informed patient-centered management recommendations towards the goal of preventing future CVD events. Imaging tests that can assist the clinician with the diagnosis and prognosis of CVD include imaging studies of the heart and vascular system, as well as imaging studies of other body organs applicable to CVD risk. The American Society for Preventive Cardiology (ASPC) has published “Ten Things to Know About Ten Cardiovascular Disease Risk Factors.” Similarly, this “ASPC Top Ten Imaging” summarizes ten things to know about ten imaging studies related to assessing CVD and CVD risk, listed in tabular form. The ten imaging studies herein include: (1) coronary artery calcium imaging (CAC), (2) coronary computed tomography angiography (CCTA), (3) cardiac ultrasound (echocardiography), (4) nuclear myocardial perfusion imaging (MPI), (5) cardiac magnetic resonance (CMR), (6) cardiac catheterization [with or without intravascular ultrasound (IVUS) or coronary optical coherence tomography (OCT)], (7) dual x-ray absorptiometry (DXA) body composition, (8) hepatic imaging [ultrasound of liver, vibration-controlled transient elastography (VCTE), CT, MRI proton density fat fraction (PDFF), magnetic resonance spectroscopy (MRS)], (9) peripheral artery / endothelial function imaging (e.g., carotid ultrasound, peripheral doppler imaging, ultrasound flow-mediated dilation, other tests of endothelial function and peripheral vascular imaging) and (10) images of other body organs applicable to preventive cardiology (brain, kidney, ovary). Many cardiologists perform cardiovascular-related imaging. Many non-cardiologists perform applicable non-cardiovascular imaging. Cardiologists and non-cardiologists alike may benefit from a working knowledge of imaging studies applicable to the diagnosis and prognosis of CVD and CVD risk – both important in preventive cardiology.

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Myocardial infarction with non-obstructive coronary arteries (MINOCA): Intracoronary imaging-based diagnosis and management

Cited by 35 publications

References 60 publications

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

Biomarkers of Coronary Microvascular Dysfunction in Patients With Microvascular Angina: A Narrative Review

Electrocardiographic, echocardiographic and lipid parameters in predicting obstructive coronary artery disease in patients with non-ST elevation acute coronary syndrome

Ten things to know about ten imaging studies: A preventive cardiology perspective (“ASPC top ten imaging”)

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