Role of Cardiac Magnetic Resonance Imaging in the Evaluation of MINOCA

Daneshrad, Justin A.; Ordovás, Karen; Sierra-Galan, Lilia M.; Hays, Allison G.; Mamas, Mamas A.; Bucciarelli-Ducci, Chiara; Parwani, Purvi

doi:10.3390/jcm12052017

Cited by 6 publications

(3 citation statements)

References 56 publications

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“…CMR is thought to be an important diagnostic technique for these patients. In addition, a recent study demonstrates that the presence of late-gadolinium enhancement (LGE) in CMR in MINOCA patients results in worse prognosis compared to patients not presenting LGE in CMR [41]. In our study, limited patients underwent CMR, and alternative parameters were used to define the MINOCA patients.…”

Section: Discussionmentioning

confidence: 99%

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

Kacmaz,

Schlettert,

Kreimer

et al. 2024

JCM

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Background: The development and course of myocardial infarction with non-obstructive coronary artery (MINOCA) disease is still not fully understood. In this study, we aimed to examine the baseline characteristics of in-hospital outcomes and long-term outcomes of a cohort of troponin-positive patients without obstructive coronary artery disease based on different left ventricular ejection fractions (LVEFs). Methods and results: We included a cohort of 254 patients (mean age: 64 (50.8–75.3) years, 120 females) with suspected myocardial infarction and no obstructive coronary artery disease (MINOCA) in our institutional database between 2010 and 2021. Among these patients, 170 had LVEF ≥ 50% (84 females, 49.4%), 31 patients had LVEF 40–49% (15 females, 48.4%), and 53 patients had LVEF < 40% (20 females, 37.7%). The mean age in the LVEF ≥ 50% group was 61.5 (48–73) years, in the LVEF 40–49% group was 67 (57–78) years, and in the LVEF < 40% group was 68 (56–75.5) years (p = 0.05). The mean troponin value was highest in the LVEF < 40% group, at 3.8 (1.7–4.6) µg/L, and lowest in the LVEF ≥ 50% group, at 1.1 (0.5–2.1) µg/L (p = 0.05). Creatine Phosphokinase (CK) levels were highest in the LVEF ≥ 50% group (156 (89.5–256)) and lowest in the LVEF 40–49% group (127 (73–256)) (p < 0.05), while the mean BNP value was lowest in the LVEF ≥ 50% group (98 (48–278) pg/mL) and highest in the <40% group (793 (238.3–2247.5) pg/mL) (p = 0.001). Adverse in-hospital cardiovascular events were highest in the LVEF < 40% group compared to the LVEF 40–49% group and the LVEF ≥ 50% group (56% vs. 55% vs. 27%; p < 0.001). Over a follow-up period of 6.2 ± 3.1 years, the all-cause mortality was higher in the LVEF < 40% group compared to the LVEF 40–49% group and the LVEF ≥ 50% group. Among the different factors, LVEF < 40% and LVEF 40–49% were associated with an increased risk of in-hospital cardiovascular events in the multivariable Cox regression analysis. Conclusions: LVEF has different impacts on in-hospital cardiovascular events in this cohort. Furthermore, LVEF influences long-term all-cause mortality.

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Section: Discussionmentioning

confidence: 99%

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

Kacmaz,

Schlettert,

Kreimer

et al. 2024

JCM

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“…An EGE ratio of 4 is considered pathological, with healthy skeletal muscle as reference, and the increase in relative myocardial signal intensity greater than 45% suggestive of myocardial inflammation (Fig. 1 ) 7 .…”

Section: Cardiac Mri and The Diagnosis Of Myocarditismentioning

confidence: 99%

Diagnostic criteria for myocarditis on cardiac magnetic resonance imaging: an educational review

Joudar

Aichouni

Nasri

et al. 2023

Annals of Medicine &Amp; Surgery

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Acute myocarditis represents one of the most mysterious acute cardiovascular diseases due to the great diversity of its clinical presentation, ranging from simple symptoms such as flu-like syndrome to lethal conditions such as cardiogenic shock or sudden cardiac death. The diagnosis will be suspicious in the presence of chest pain in a subject with risk factors, and guided mainly by the ECG, biological markers, trans-thoracic echocardiography, and the cardiac MRI. In this sense, and returning to the pathophysiological bases of this condition, the positive diagnosis will rely mainly on the detection of tissue abnormalities secondary to the myocardial inflammatory storm. Cardiac MRI represents a diagnostic pillar, given the information it can provide, both in analyzing the morphology, and the myocardial function but also tissue abnormalities that represent the main element of the diagnostic criteria of Lake Louisse.

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“…Intravascular imaging such as coronary optical coherence tomography, along with CMR, are essential steps in diagnosing these patients, allowing the proper differential diagnosis, targeted treatment, and prognosis. 121,123 Furthermore, women have been historically underrepresented in cardiovascular clinical trials compared to their disease burden in the population, limiting the data on the efficacy of cardiovascular therapies in women compared to men. [124][125][126][127][128] Adequate representation of women and diverse populations in future cardiovascular trials is critical to ensure that the results from the trial apply to the broad groups of patients being cared for in clinical practice.…”

Section: Subclinical Atherosclerosis Assessmentmentioning

confidence: 99%

A Woman’s Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations

Kazzi,

Shankar,

Elder-Odame

et al. 2023

IJWH

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Mid-life, the years leading up to and following the menopause transition, in women is accompanied by a change in cardiometabolic risk factors, including increases in body weight, changes in body composition, a more insulin-resistant state, and a shift towards a more atherogenic dyslipidemia pattern. Cardiovascular disease (CVD) risk assessment should be performed continually throughout the lifespan, as risk is not stagnant and can change throughout the life course. However, mid-life is a particularly important time for a woman to be evaluated for CVD risk so that appropriate preventive strategies can be implemented. Along with assessing traditional risk factors, ascertainment of a reproductive history is an integral part of a comprehensive CVD risk assessment to recognize unique female-specific or female-predominant factors that modify a woman's risk. When there is uncertainty about CVD risk and the net benefit of preventive pharmacotherapy interventions (such as statins), measuring a coronary artery calcium score can help further refine risk and guide shared decision-making. Additionally, there should be heightened sensitivity around identifying signs and symptoms of ischemic heart disease in women, as these may present differently than in men. Ischemia from coronary microvascular disease and/or vasospasm may be present even without obstructive coronary artery disease and is associated with a heightened risk for major cardiovascular events and reduced quality of life. Therefore, correctly identifying CVD in women and implementing preventive and treatment therapies is paramount. Unfortunately, women are underrepresented in cardiovascular clinical trials, and more data are needed about how to best incorporate novel and emerging risk factors into CVD risk assessment. This review outlines an approach to CVD screening and risk assessment in women using several methods, focusing on the middle-aged population.

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Role of Cardiac Magnetic Resonance Imaging in the Evaluation of MINOCA

Cited by 6 publications

References 56 publications

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

Ejection Fraction-Related Differences of Baseline Characteristics and Outcomes in Troponin-Positive Patients without Obstructive Coronary Artery Disease

Diagnostic criteria for myocarditis on cardiac magnetic resonance imaging: an educational review

A Woman’s Heart: Improving Uptake and Awareness of Cardiovascular Screening for Middle-Aged Populations

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