OCT and CMR for the Diagnosis of Patients Presenting With MINOCA and Suspected Epicardial Causes

Gerbaud, Édouard; Arabucki, Fabien; Nivet, Hubert; Barbey, Christophe; Cetran, Laura; Chassaing, Stéphan; Séguy, B; Lesimple, Arnaud; Cochet, Hubert; Montaudon, Michel; Laurent, François; Bar, Olivier; Tearney, Guillermo J.; Coste, Pierre

doi:10.1016/j.jcmg.2020.05.045

Cited by 72 publications

(61 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results of our systematic review indicate that CMR resulted in a diagnosis of takotsubo syndrome, myocarditis or cardiomyopathy in 26%, 11% and 7%, respectively. These results are in agreement with recent findings emphasizing the importance of performing CMR in MINOCA patients to correctly identify myocarditis and other 'non coronary' causes of myocardial injury justifying the increasing use of this technique over the past 15 years [5,12].…”

Section: Subacute Phase Of Minocasupporting

confidence: 91%

“…They are useful for the diagnosis of heart failure and related classification (ie preserved vs. reduced ejection fraction). Intracoronary imaging (e.g., IVUS and OCT), identifies, localizes, and quantifies alternative atherosclerotic mechanisms, such as plaque rupture, erosion or ulceration or coronary artery dissection [5][6][7].…”

Section: Assessment In the Acute Phasementioning

confidence: 99%

“…The presentation of MINOCA is that of an acute coronary syndrome (ACS) and most patients are therefore referred to the cath lab for emergency coronary angiography immediately after triage. In the acute phase, number of tools in addition to coronary angiography and left ventriculography are now available in the cath lab to investigate pathophysiologic mechanisms underlying MINOCA [5][6][7]. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) provide a more precise evaluation of coronary anatomy and plaque characteristics [8] whilst assessments of coronary physiology and vasomotor disorders provide information on the hemodynamic significance of sub-critical atherosclerosis, epicardial spasm, and microvascular function [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Subacute Phase Of Minocasupporting

confidence: 91%

Section: Assessment In the Acute Phasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…28 Gerbaud et al showed excellent diagnostic efficacy with concomitant OCT imaging and confirmatory CMRI in MINOCA patients presenting with a ST-elevation MI. 29 Another prospective study with MINOCA patients showed good correlation between infarct-related artery with plaque rupture identified on OCT imaging with matching ischemic-type LGE on CMRI on serial imaging. 30 In a study of 107 patients undergoing evaluation for a possible diagnosis of MINOCA, CMRI was able to diagnose myocarditis in 60%, AMI in 16%, takotsubo cardiomyopathy in 14%, and normal findings in 10% of patients.…”

Section: Diagnostic Evaluationmentioning

confidence: 94%

Myocardial Infarction with Nonobstructive Coronary Artery Disease—Definition, Etiopathogenesis, Diagnosis, and Management

et al. 2021

View full text Add to dashboard Cite

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a complex clinical syndrome that is characterized by evidence of acute myocardial infarction in the absence of significant epicardial coronary artery disease on angiography. The term “MINOCA” encompasses a group of heterogeneous diseases with varying underlying mechanisms and each with its own pathophysiology. Overlooked plaque rupture or erosion and coronary vasospasm are the most common causes of MINOCA and can be diagnosed by routine intracoronary imaging and vasoreactivity testing, respectively. Coronary microvascular dysfunction is a less recognized, albeit an important cause of morbidity in patients presenting with MINOCA. Although MINOCA is a rare presentation of acute coronary syndrome, it is not a benign disorder and can have adverse consequences if untreated. In this article, we aim to review the pathogenesis, clinical characteristics, and finally propose a systematic approach in the diagnosis and management of patients with MINOCA.

show abstract

“…In a more recent study presented by Gerabaud et al 40 patients with MINOCA underwent both OCT and CMR [50]. Optical coherence tomography provided a diagnosis of AMI in 80% of patients including 35% with plaque rupture, 30% with plaque erosion, 7.5% with lone thrombus, 5% with SCAD, and 2.5% with calcified nodule.…”

Section: Oct In Minocamentioning

confidence: 97%

OCT Findings in MINOCA

Bryniarski

Gąsior

Legutko

et al. 2021

JCM

View full text Add to dashboard Cite

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

show abstract

OCT and CMR for the Diagnosis of Patients Presenting With MINOCA and Suspected Epicardial Causes

Cited by 72 publications

References 21 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 Artery Disease—Definition, Etiopathogenesis, Diagnosis, and Management

OCT Findings in MINOCA

Contact Info

Product

Resources

About