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La S, Beltrame J, Tavella R. Sex-specific and ethnicity-specific differences in MINOCA. Nat Rev Cardiol 2024; 21:192-202. [PMID: 37775559 DOI: 10.1038/s41569-023-00927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Abstract
Suspected myocardial infarction with non-obstructive coronary arteries (MINOCA) has received increasing attention over the past decade. Given the heterogeneity in the mechanisms underlying acute myocardial infarction in the absence of obstructive coronary arteries, the syndrome of MINOCA is considered a working diagnosis that requires further investigation after diagnostic angiography studies have been performed, including coronary magnetic resonance angiography and functional angiography. Although once considered an infrequent and low-risk form of myocardial infarction, recent data have shown that the prognosis of MINOCA is not as benign as previously assumed. However, despite increasing awareness of the condition, many questions remain regarding the diagnosis, risk stratification and treatment of MINOCA. Women seem to be more susceptible to MINOCA, but studies on the sex-specific differences of the disease are scarce. Similarly, ethnicity-specific factors might explain discrepancies in the observed prevalence or underlying pathophysiological mechanisms of MINOCA but data are also scarce. Therefore, in this Review, we provide an update on the latest evidence available on the sex-specific and ethnicity-specific differences in the clinical features, pathophysiological mechanisms, treatment and prognosis of MINOCA.
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Affiliation(s)
- Sarena La
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - John Beltrame
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Rosanna Tavella
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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Samaras A, Moysidis DV, Papazoglou AS, Rampidis G, Kampaktsis PN, Kouskouras K, Efthymiadis G, Ziakas A, Fragakis N, Vassilikos V, Giannakoulas G. Diagnostic Puzzles and Cause-Targeted Treatment Strategies in Myocardial Infarction with Non-Obstructive Coronary Arteries: An Updated Review. J Clin Med 2023; 12:6198. [PMID: 37834842 PMCID: PMC10573806 DOI: 10.3390/jcm12196198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a distinct subtype of myocardial infarction (MI), occurring in about 8-10% of spontaneous MI cases referred for coronary angiography. Unlike MI with obstructive coronary artery disease, MINOCA's pathogenesis is more intricate and heterogeneous, involving mechanisms such as coronary thromboembolism, coronary vasospasm, microvascular dysfunction, dissection, or plaque rupture. Diagnosing MINOCA presents challenges and includes invasive and non-invasive strategies aiming to differentiate it from alternative diagnoses and confirm the criteria of elevated cardiac biomarkers, non-obstructive coronary arteries, and the absence of alternate explanations for the acute presentation. Tailored management strategies for MINOCA hinge on identifying the underlying cause of the infarction, necessitating systematic diagnostic approaches. Furthermore, determining the optimal post-MINOCA medication regimen remains uncertain. This review aims to comprehensively address the current state of knowledge, encompassing diagnostic and therapeutic approaches, in the context of MINOCA while also highlighting the evolving landscape and future directions for advancing our understanding and management of this intricate myocardial infarction subtype.
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Affiliation(s)
- Athanasios Samaras
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
- Second Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
- Third Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Georgios Rampidis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Polydoros N. Kampaktsis
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY 10032, USA;
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital of Thessaloniki, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Georgios Efthymiadis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Nikolaos Fragakis
- Second Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Vasileios Vassilikos
- Third Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
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Gomes Cochicho J, Silva JM, Louro R, Lavadinho I. An Incidental Myxoma Hidden in Chest Pain. Cureus 2023; 15:e45340. [PMID: 37849609 PMCID: PMC10577510 DOI: 10.7759/cureus.45340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Chest pain is a very common symptom in an emergency context. Its differential diagnosis is extensive and includes some conditions that require immediate recognition and intervention. It can also be a symptom associated with rarer diagnostic possibilities. Here, we report the case of a 53-year-old woman admitted to the emergency department due to chest pain and initially diagnosed with non-ST elevation acute myocardial infarction. A transthoracic echocardiogram revealed a large hyperechogenic round mass, suggestive of a left atrial cardiac myxoma. Coronary angiography showed no significant lesions. The patient underwent cardiac surgery with excision of the mass, whose histological diagnosis was atrial myxoma. The immediate postoperative period was uneventful, and the patient was discharged asymptomatic and without echocardiographic changes. Cardiac tumors are a rare finding, of which myxomas are the most common. Symptoms can typically result from embolism, obstruction, or constitutional symptoms. A myxoma presenting as acute chest pain and mimicking an acute coronary syndrome is an uncommon finding. This case reminds us of an extremely rare differential diagnosis of chest pain and awakens us to the usefulness and importance of using echocardiography as a diagnostic tool.
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Affiliation(s)
- Joana Gomes Cochicho
- Internal Medicine Department, Hospital Doutor José Maria Grande, Portalegre, PRT
| | - José Miguel Silva
- Internal Medicine Department, Hospital Doutor José Maria Grande, Portalegre, PRT
| | - Rita Louro
- Internal Medicine Department, Hospital Doutor José Maria Grande, Portalegre, PRT
| | - Isabel Lavadinho
- Internal Medicine Department, Unidade Local de Saúde do Norte Alentejano, Portalegre, PRT
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Parwani P, Kang N, Safaeipour M, Mamas MA, Wei J, Gulati M, Naidu SS, Merz NB. Contemporary Diagnosis and Management of Patients with MINOCA. Curr Cardiol Rep 2023; 25:561-570. [PMID: 37067753 DOI: 10.1007/s11886-023-01874-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Myocardial infarction with nonobstructive coronary arteries (MINOCA) is defined as acute myocardial infarction (MI) with angiographically no obstructive coronary artery disease or stenosis ≤ 50%. MINOCA is diagnostically challenging and complex, making it difficult to manage effectively. This condition accounts for 6-8% of all MI and poses an increased risk of morbidity and mortality after diagnosis. Prompt recognition and targeted management are essential to improve outcomes and our understanding of this condition, but this process is not yet standardized. This article offers a comprehensive review of MINOCA, delving deep into its unique clinical profile, invasive and noninvasive diagnostic strategies for evaluating MINOCA in light of the lack of widespread availability for comprehensive testing, and current evidence surrounding targeted therapies for patients with MINOCA. RECENT FINDINGS MINOCA is not uncommon and requires comprehensive assessment using various imaging modalities to evaluate it further. MINOCA is a heterogenous working diagnosis that requires thoughtful approach to diagnose the underlying disease responsible for MINOCA further.
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Affiliation(s)
- Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA.
- Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Nicolas Kang
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Mary Safaeipour
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Janet Wei
- Barbara Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Martha Gulati
- Barbara Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Srihari S Naidu
- Department of Cardiology, Westchester Medical Center, Valhalla, NY, USA
| | - Noel Bairey Merz
- Barbara Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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Mileva N, Paolisso P, Gallinoro E, Fabbricatore D, Munhoz D, Bergamaschi L, Belmonte M, Panayotov P, Pizzi C, Barbato E, Penicka M, Andreini D, Vassilev D. Diagnostic and Prognostic Role of Cardiac Magnetic Resonance in MINOCA: Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:376-389. [PMID: 36889851 DOI: 10.1016/j.jcmg.2022.12.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) is common in current clinical practice. Cardiac magnetic resonance (CMR) plays an important role in its management and is increasingly recommended by all the current guidelines. However, the prognostic value of CMR in patients with MINOCA is still undetermined. OBJECTIVES The purpose of this study was to determine the diagnostic and prognostic value of CMR in the management of patients with MINOCA. METHODS A systematic review was performed to identify studies reporting the results of CMR findings in patients with MINOCA. Random effects models were used to determine the prevalence of different disease entities: myocarditis, myocardial infarction (MI), or takotsubo syndrome. Pooled odds ratios (ORs) and 95% CIs were calculated to evaluate the prognostic value of CMR diagnosis in the subgroup of studies that reported clinical outcomes. RESULTS A total of 26 studies comprising 3,624 patients were included. The mean age was 54.2 ± 5.3 years, and 56% were men. MINOCA was confirmed in only 22% (95% CI: 0.17-0.26) of the cases and 68% of patients with initial MINOCA were reclassified after the CMR assessment. The pooled prevalence of myocarditis was 31% (95% CI: 0.25-0.39), and takotsubo syndrome 10% (95% CI: 0.06-0.12). In a subgroup analysis of 5 studies (770 patients) that reported clinical outcomes, CMR diagnosis of confirmed MI was associated with an increased risk of major adverse cardiovascular events (pooled OR: 2.40; 95% CI: 1.60-3.59). CONCLUSIONS In patients with MINOCA, CMR has been demonstrated to add an important diagnostic and prognostic value, proving to be crucial for the diagnosis of this condition. Sixty-eight percent of patients with initial MINOCA were reclassified after the CMR evaluation. CMR-confirmed diagnosis of MINOCA was associated with an increased risk of major adverse cardiovascular events at follow-up.
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Affiliation(s)
- Niya Mileva
- Specialized Cardiovascular Hospital "Medica Cor," Ruse, Bulgaria; Medical University of Sofia, Sofia, Bulgaria.
| | - Pasquale Paolisso
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy; Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy
| | - Emanuele Gallinoro
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Davide Fabbricatore
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Daniel Munhoz
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Department of Clinical Medicine, Discipline of Cardiology, University of Campinas UNICAMP, Campinas, Brazil
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marta Belmonte
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences-University of Naples, Federico II, Italy; Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Martin Penicka
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Dobrin Vassilev
- Specialized Cardiovascular Hospital "Medica Cor," Ruse, Bulgaria; University of Ruse "Angel Kanchev," Ruse, Bulgaria
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Nepal S, Caicedo Murillo ML, Ojha K, Lamichhane M. A Left Atrial Myxoma Masquerading As Acute Coronary Syndrome. Cureus 2022; 14:e29300. [PMID: 36277524 PMCID: PMC9580039 DOI: 10.7759/cureus.29300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/23/2022] Open
Abstract
Acute coronary syndrome is caused by a rupture of atherosclerotic plaque with superimposed thrombus formation. Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) occurs when occlusion of the epicardial coronary artery by a thrombus causes partial thickness myocardial ischemia and an ischemic cascade downstream. Cardiac masses are known to produce symptoms predominantly by local obstruction or systemic embolism. Coronary artery tumor embolism causing acute coronary syndrome is a rare presentation of cardiac mass. We report NSTE-ACS as the initial presentation of the left atrial myxoma in a 62-year-old woman. She presented to the emergency department with acute onset severe anginal chest pain, diaphoresis, and dizziness. Her serial electrocardiograms (ECGs) were normal, and serial troponins were elevated, consistent with non-ST-segment elevation acute coronary syndrome. Cardiac catheterization revealed insignificant coronary artery disease, and transthoracic and transesophageal echocardiograms showed a left atrial mass attached to the interatrial septum consistent with myxoma. The patient underwent surgical excision, and histopathology was consistent with myxoma. Her symptoms subsided after surgery. Primary cardiac tumors are very uncommon and can present with myriad symptoms, from tumor embolism, local cardiac effects, to constitutional symptoms. Although embolism to other organs has been reported, left atrial myxoma presenting as an acute coronary syndrome is very uncommon.
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Mantovani F, Paolini A, Barbieri A, Boriani G. Case Report: Free-Floating Intracoronary Thrombus: Who Is the Convict? Front Oncol 2022; 12:825711. [PMID: 35350576 PMCID: PMC8957839 DOI: 10.3389/fonc.2022.825711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/08/2022] [Indexed: 02/02/2023] Open
Abstract
In young patients, especially with no traditional coronary risk factors, hypercoagulable states may always be considered as an alternative cause of acute coronary syndromes. The concomitant thrombotic and bleeding risk associated with myeloproliferative disorders complicates the decision-making, particularly regarding long-term dual antiplatelet therapy. The chosen therapy may need to be frequently revisited, depending on the patient's bleeding complications. We reported the case of a 49-year-old woman with acute myocardial infarction with no traditional risk factors for coronary artery disease where a myeloproliferative neoplasm was diagnosed.
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Affiliation(s)
- Francesca Mantovani
- Dipartimento di Medicine Specialistiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ambra Paolini
- Department of Medical and Surgical Sciences, Haematology Unit, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Andrea Barbieri
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
| | - Giuseppe Boriani
- Department of Cardiology, Policlinico Hospital, Modena and Reggio Emilia University, Modena, Italy
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Balakrishna AM, Ismayl M, Thandra A, Walters R, Ganesan V, Anugula D, Shah DJ, Aboeata A. Diagnostic value of Cardiac Magnetic Resonance Imaging and Intracoronary Optical Coherence Tomography in patients with a working diagnosis of Myocardial Infarction with Non-obstructive Coronary Arteries - A Systematic review and Meta-analysis. Curr Probl Cardiol 2022; 48:101126. [PMID: 35120967 DOI: 10.1016/j.cpcardiol.2022.101126] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to study the efficacy of cardiac magnetic resonance imaging (CMR) and intracoronary optical coherence tomography (OCT) in detecting the etiology of myocardial infarction with non-obstructive coronary arteries (MINOCA). METHODS A systematic search was conducted in PubMed, Medline, and Cochrane databases. Search terms used: Myocardial infarction, Coronary angiography, Normal coronary arteries, CMR, and OCT. Inclusion criteria was fulfilled by 18 studies. Meta-analysis was performed with 15 studies. RESULTS A total of 2697 patients were included. The mean age of all the patients was 51.5 and 56.4% were men. CMR established diagnosis in 74% of the patients; 29% had acute myocarditis, 18% had true myocardial infarction and 12% had takotsubo cardiomyopathy. Combining OCT with CMR was better at finding the etiology than either modality individually. CONCLUSION CMR is integral in identifying the etiology of MINOCA. Coupling OCT and CMR is better than either technique individually at finding the cause.
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Affiliation(s)
| | - Mahmoud Ismayl
- Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Abhishek Thandra
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
| | - Ryan Walters
- Department of Clinical Research, Creighton University, Omaha, NE, USA
| | - Vaishnavi Ganesan
- Division of Internal Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Dixitha Anugula
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA
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Wan ZH, Wang J, Zhao Q. Acute myocardial infarction in a young man with ankylosing spondylitis: A case report. World J Clin Cases 2021; 9:11392-11399. [PMID: 35071570 PMCID: PMC8717491 DOI: 10.12998/wjcc.v9.i36.11392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/29/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints. To the best of our knowledge, AS with acute myocardial infarction (AMI) has rarely been reported. Here, we report an unusual case of AS with AMI in a young patient.
CASE SUMMARY A 37-year-old man was admitted to the Department of Rheumatology and Immunology of our hospital on March 14, 2020, for low back pain. Further evaluation with clinical examinations, laboratory tests, and imaging resulted in a diagnosis of AS. Treatment with a non-steroidal anti-inflammatory drug and a tumor necrosis factor inhibitor partially improved his symptoms. However, his back pain persisted. After 6 wk of treatment, he was admitted to the emergency room of another hospital in this city for sudden-onset severe chest pain consistent with a diagnosis of AMI. Angiography revealed severe narrowing of the coronary arteries. Surgical placement of two coronary stents completely relieved his back pain.
CONCLUSION AS can cause cardiovascular diseases, including AMI. It is important to consider the cardiovascular risks in the management of AS.
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Affiliation(s)
- Zhi-Hong Wan
- Department of Rheumatology and Immunology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Jing Wang
- Department of Rheumatology and Immunology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Qing Zhao
- Department of Rheumatology and Immunology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
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How I treat unexplained arterial thrombosis. Blood 2021; 136:1487-1498. [PMID: 32584955 DOI: 10.1182/blood.2019000820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/22/2020] [Indexed: 12/27/2022] Open
Abstract
Most arterial thrombotic events have a clear atherosclerotic or cardioembolic etiology, but hematologists are frequently asked to assist in the diagnosis and management of a patient with a nonatherosclerotic and noncardioembolic arterial event, referred to here as an unexplained arterial thrombosis. Because there is an assorted list of factors that can precipitate an arterial event, we present a systematic diagnostic approach to ensure consideration of not only primary hypercoagulable disorders, but also pro-thrombotic medications or substances, vascular and anatomic abnormalities, and undiagnosed systemic disorders, such as malignancy and autoimmune diseases. We also review existing literature of the role of hypercoagulable disorders in arterial thrombosis and discuss our approach to thrombophilia workup in patients after an unexplained arterial event. We conclude with 3 representative cases to both illustrate the application of the outlined diagnostic schema and discuss common management considerations, specifically the selection of anticoagulation vs antiplatelet therapy for secondary prevention.
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11
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Jamil S, Jamil G, Mesameh H, Qureshi A, AlKaabi J, Sharma C, Aziz F, Al-Shamsi AR, Yasin J. Risk factor comparison in young patients presenting with acute coronary syndrome with atherosclerotic coronary artery disease vs. angiographically normal coronaries. Int J Med Sci 2021; 18:3526-3532. [PMID: 34522179 PMCID: PMC8436094 DOI: 10.7150/ijms.60869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/07/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Acute myocardial infarction is a relatively rare phenomenon in the young population. The incidence has nevertheless increased from years past, likely due to the presence of multiple risk factors from an increasingly younger age. Regardless of whether they have atherosclerotic coronary artery disease or normal coronary angiogram, young patients with risk factors for coronary artery disease (CAD), chest pain, and positive troponin, are initially treated in a similar fashion. Our goal was to shed light on whether risk factors between these two groups differ to help guide physicians in clinically determining whether or not an atherosclerotic cardiovascular event has occurred, as well as to potentially identify young patients at risk of acute coronary syndrome (ACS) despite normal coronary arteries. Methods: A retrospective cross sectional study was undertaken over an 8 year period at Tawam Hospital. 576 patients aged 50 or under who underwent coronary angiography were selected for the study. Medical records were analyzed for the patient's demographics and CAD risk factor profile, including the following variables: family history of CAD, smoking status, Body Mass Index category, lipid profile, and diagnosis of hyperlipidemia, diabetes, or hypertension. Details of the coronary angiogram were also reviewed. Results: Statistically significant outcomes included a higher prevalence of diabetes, hyperlipidemia, and smoking history in patients with CAD compared to the patients with normal coronary angiogram. Diabetes was one of the strongest risk factors in CAD patients, with an odds ratio of 1.98 (p= 0.011), followed by hyperlipidemia at 1.85 (p= 0.021). Smoking history had an odds ratio of 2.93 (p <0.001). Conclusion: Risk factors were present in both groups, but significantly more in the CAD group. No particular risk factor stood out for the development of ACS in those with normal coronary arteries, other than mean BMI being slightly higher in this group. Based on our analysis, no single variable can accurately predict the risk for ACS in normal coronaries. To our knowledge, few studies have been done in the young population with angiographically normal coronary arteries to determine possible risk factors for development of ACS. Further research needs to be done to determine whether the risk factors that were common amongst both groups are coincidental, or a cause of ACS in those with normal coronary arteries.
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Affiliation(s)
- Sarah Jamil
- Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Gohar Jamil
- Department of Cardiology, Tawam Hospital, Al Ain, United Arab Emirates.,Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hanaa Mesameh
- Nursing, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Juma AlKaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Javed Yasin
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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12
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Myocardial Infarction With Nonobstructive Coronary Arteries. Cardiol Rev 2020; 29:110-114. [PMID: 32947482 DOI: 10.1097/crd.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is the current term used to describe patients who have a myocardial infarction but have normal, non-obstructed coronary arteries on a coronary angiogram. There is still much debate over the definition, diagnosis, management and treatment of MINOCA. However, MINOCA is not a benign condition; prompt recognition and diagnosis can lead to better management and treatment and thus improve patient outcomes. This review article will update the most recent definition of MINOCA, discuss epidemiology and etiology, and review the diagnostic workup and management options for patients presenting with signs and symptoms of MINOCA.
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13
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Escalon JG, Bang TJ, Broncano J, Vargas D. Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Potential Etiologies, Mimics and Imaging Findings. Curr Probl Diagn Radiol 2020; 50:85-94. [PMID: 32513516 DOI: 10.1067/j.cpradiol.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/06/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs when a patient presents with positive cardiac enzymes in the absence of obstructive atherosclerosis on coronary angiography. Several hypotheses for the pathogenesis of MINOCA have been suggested and multiple potential underlying etiologies have been reported. This review will outline the reported causes of MINOCA and associated major imaging features. In doing so, it will increase awareness of this entity and equip cardiac imagers with the knowledge to appropriately tailor imaging to make a prompt and accurate diagnosis.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY.
| | - Tami J Bang
- Department of Radiology, Division of Cardiopulmonary Imaging, University of Colorado School of Medicine, Aurora, CO
| | - Jordi Broncano
- Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA, Health Time Group, Cordoba, Spain
| | - Daniel Vargas
- Department of Radiology, Division of Cardiopulmonary Imaging, University of Colorado School of Medicine, Aurora, CO
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14
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Hajhosseiny R, Bahaei TS, Prieto C, Botnar RM. Molecular and Nonmolecular Magnetic Resonance Coronary and Carotid Imaging. Arterioscler Thromb Vasc Biol 2020; 39:569-582. [PMID: 30760017 DOI: 10.1161/atvbaha.118.311754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerosis is the leading cause of cardiovascular morbidity and mortality. Over the past 2 decades, increasing research attention is converging on the early detection and monitoring of atherosclerotic plaque. Among several invasive and noninvasive imaging modalities, magnetic resonance imaging (MRI) is emerging as a promising option. Advantages include its versatility, excellent soft tissue contrast for plaque characterization and lack of ionizing radiation. In this review, we will explore the recent advances in multicontrast and multiparametric imaging sequences that are bringing the aspiration of simultaneous arterial lumen, vessel wall, and plaque characterization closer to clinical feasibility. We also discuss the latest advances in molecular magnetic resonance and multimodal atherosclerosis imaging.
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Affiliation(s)
- Reza Hajhosseiny
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,National Heart and Lung Institute, Imperial College London, United Kingdom (R.H.)
| | - Tamanna S Bahaei
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.)
| | - Claudia Prieto
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
| | - René M Botnar
- From the School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom (R.H., T.S.B., C.P., R.M.B.).,Escuela de Ingeniería, Pontificia Universidad Catolica de Chile, Santiago, Chile (C.P., R.M.B.)
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15
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Riga JP, Leone A, Lambot F, Cappeliez O, Friart A. A microvascular myocardial infarction in a 16-year-old girl with antiphospholipid syndrome: a case report. Acta Clin Belg 2019; 74:351-354. [PMID: 30160190 DOI: 10.1080/17843286.2018.1516182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective and importance: The antiphospholipid syndrome can manifest itself by silent (or not) myocardial infarction. Clinical presentation: We report the case of a 16-year-old girl who presented a myocardial infarction for whom a coronary-computer tomography did not reveal any coronary abnormalities or obstruction. She had a livedo reticularis on her physical exam. Intervention: The echocardiography showed a normal left ventricular function and a mild eccentric mitral regurgitation. A myocardial magnetic resonance imaging demonstrated transmural necrosis with microvascular obstruction at the inferobasal segment of the left ventricle, suggestive of a microvascular myocardial infarction. The blood test showed elevation of the three antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein). The lupus anticoagulant remained positive 12 weeks later, fulfilling the laboratory criteria for antiphospolipid carrier. The associated presence of this microvascular coronary obstruction was strongly suggestive of antiphospholipd syndrome, according to the revised Sapporo criteria. To our knowledge, this is the first reported case of antiphospholipid syndrome manifesting as an acute microvascular myocardial infarction, confirmed by myocardial magnetic resonance imaging. Conclusion: The antiphospholipid syndrome can manifest itself early by a microvascular myocardial infarction. The clinician has to be alerted by a livedo reticularis in these patients, which will be frequently associated with manifestations of antiphospholipid syndrome such as arterial thrombosis and valvulopathies.
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Affiliation(s)
- Jean-Philippe Riga
- Cardiology, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Attilio Leone
- Cardiology, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Frédéric Lambot
- Internal Medicine, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Olivier Cappeliez
- Medical Imaging, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Alain Friart
- Cardiology, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
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16
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Benamer H, Saighi Bouaouina M, Masri A, Sarkis G, El Beze N, Millien V. [Vasospastic angina: An under-diagnosed pathology]. Ann Cardiol Angeiol (Paris) 2019; 68:341-346. [PMID: 31542201 DOI: 10.1016/j.ancard.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/28/2019] [Indexed: 12/31/2022]
Abstract
The clinical and physiopathological clinical entity known as spastic angina or variant angina has been long documented. It remains, however, an under-estimated condition, which is insufficiently diagnosed and explored. This pathology is associated with severe complications such as heart rhythm disorders, which may potentially result in ventricular fibrillation and cause sudden death. In Japan, this condition occurs more frequently and is better documented. Stimulation tests are also carried out more often and have a higher positivity rate than in France where vasospastic angina is less frequently reported and where provocation tests are associated with negative results and are, consequently, performed less often. In order to improve the detection of this pathology, its potential presence should be explored in patients with rest angina who experience chest pain in the second half of the night and also in instances of acute coronary syndrome with sudden death and no angiographically visible coronary artery disease. The diagnosis should be confirmed by means of ergonovine provocation tests. In order to enhance the sensitivity of these tests without increasing the risk of complications, injection of ergonovine should be preferably carried out via the intracoronary route. By increasing the frequency and sensitivity of these tests, this pathology, which responds well to medical treatment in many cases, could be amenable to therapeutic management as any other form of coronary artery disease.
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Affiliation(s)
- H Benamer
- Groupe Ramsay générale de santé, Institut Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - M Saighi Bouaouina
- Groupe Ramsay générale de santé, Institut Jacques-Cartier, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - A Masri
- ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - G Sarkis
- ICVGVM la Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - N El Beze
- Hôpital Foch, 40, rue Worth, 92150 Suresnes, France
| | - V Millien
- Centre hospitalier Saint-Quentin, 1, rue Michel de l'Hôpital, 02100 Saint-Quentin, France
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17
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Factors Associated with Sub-intimal Coronary Artery Dissection in MINOCA Patients with Delayed Washout at Coronary Angiography – Protocol for an Observational, OCT-based Study. JOURNAL OF INTERDISCIPLINARY MEDICINE 2019. [DOI: 10.2478/jim-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) is a special form of the acute coronary syndrome. The heterogeneous pathophysiology of MINOCA is not well elucidated and includes cardiac and non-cardiac causes. Slow flow phenomenon on coronary angiography can be associated with several possible causes of MINOCA confirmed by optical coherence tomography (OCT). Therefore, the aim of this study is to assess the underlying mechanism of the delayed washout phenomenon on coronary angiography and the potential role of subintimal coronary artery dissection (SD) in the setting of an acute MI.
Methods and design: This clinical prospective, descriptive research will enroll patients diagnosed with acute MI (STEMI or NSTEMI) identified by coronary angiography, followed by OCT imaging of the coronary arteries at the Emergency Clinical County Hospital of Târgu Mureş, Romania. The enrolled patients will be separated into two groups based on OCT examination, patients with SD and patients with no SD.
Conclusion: The underlying mechanisms of MINOCA with delayed washout phenomenon on coronary angiography is still poorly understood. Modern invasive imaging techniques are capable to assess the microstructure of the coronary artery wall and are able to offer the much needed information to elucidate the pathophysiological changes which ultimately cause the acute event. The current study offers a new, complex – clinical, invasive and noninvasive imaging, as well as biomarker-based – approach, which may lead to a better understanding and treatment of this pathology.
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18
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Optical Coherence Tomography Assessment of Morphological Characteristics in Suspected Coronary Artery Disease, but Angiographically Nonobstructive Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:475-479. [DOI: 10.1016/j.carrev.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/30/2022]
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19
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Chhabra ST, Kaur T, Masson S, Soni RK, Bansal N, Takkar B, Tandon R, Goyal A, Singh B, Aslam N, Mohan B, Wander GS. Early onset ACS: An age based clinico-epidemiologic and angiographic comparison. Atherosclerosis 2018; 279:45-51. [DOI: 10.1016/j.atherosclerosis.2018.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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20
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Yakushin SS. Myocardial Infarction with Nonobstructive Coronary Arteries (МINОСА) – a Trendy Term or a New Diagnostic Concept? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-5-765-773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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21
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[Coronary spasm a diagnostic and therapeutic challenge]. Presse Med 2018; 47:798-803. [PMID: 30245142 DOI: 10.1016/j.lpm.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/05/2018] [Accepted: 08/07/2018] [Indexed: 12/15/2022] Open
Abstract
Vasospastic angina is a clinical and physio-pathological entity, which has been documented for many years, but its diagnosis is under-estimated despite the fact that though inadequately considered and investigated. This condition is potentially serious and can sometimes trigger severe arrhythmia resulting in ventricular fibrillation and sudden death. This pathology has a higher incidence in Asia, where it is, therefore, better documented with provocative testing being carried out more frequently, while in France, these tests are not sufficiently performed probably due to the fact that they often produce negative findings. Provocative tests with Ergonovine injection should be performed via intra-coronary to improve its sensibility. Should this test become more sensitive and more routinely performed, this condition, which often responds well to medical treatment, could regain appropriate recognition as a coronary disease.
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22
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Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, Reynolds HR, Geda M, Bueno H, Dziura JD, Krumholz HM, D'Onofrio G. Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. J Am Heart Assoc 2018; 7:e009174. [PMID: 29954744 PMCID: PMC6064896 DOI: 10.1161/jaha.118.009174] [Citation(s) in RCA: 242] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI-CAD]) and among patients with MINOCA by sex and subtype. METHODS AND RESULTS Between 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI-CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1- and 12-month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI-CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29-7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI-CAD patients (3.0% versus 1.3%; P=0.036). Women with MI-CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One- and 12-month mortality with MINOCA and MI-CAD was similar (1-month: 1.1% and 1.7% [P=0.43]; 12-month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12-month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06). CONCLUSIONS Young patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI-CAD patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.
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Affiliation(s)
- Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, CT
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, CT
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Rachel P Dreyer
- Department of Emergency Medicine, Yale University, New Haven, CT
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | | | | | - John A Spertus
- University of Missouri Kansas City, Kansas City, MO
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Harmony R Reynolds
- Cardiovascular Clinical Research Center, NYU School of Medicine, New York, NY
| | - Mary Geda
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - James D Dziura
- Department of Emergency Medicine, Yale University, New Haven, CT
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, CT
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale University, New Haven, CT
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23
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Kalinin RE, Suchkov IA, Mzhavanadze ND, Ncheye AF. Posterobasal left ventricular aneurysm after myocardial infarction with normal coronary arteries: Case-report. World J Clin Cases 2018; 6:139-142. [PMID: 29988903 PMCID: PMC6033746 DOI: 10.12998/wjcc.v6.i6.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/14/2018] [Accepted: 04/01/2018] [Indexed: 02/05/2023] Open
Abstract
We present a case of a 64-year-old woman with signs of debilitating condition including anginal chest pain, exertional dyspnea, and depression. The patient had previously suffered from a myocardial infarction after a loss of a close family member. Workup showed a posterobasal left ventricular aneurysm and moderate to severe mitral regurgitation in the absence of coronary atherosclerosis. Routine ultrasonography revealed abdominal aortic aneurysm and intraabdominal aortic deviation. The patient was immediately started on optimal medical treatment. On repeat assessment general condition was satisfactory, vital signs were normal, and investigations showed no signs of progressive heart failure or other significant clinical changes. Although prognosis in patients with myocardial infarction with normal coronary arteries is generally considered favorable, mechanical complications such as posterobasal left ventricular aneurysm with moderate to severe mitral regurgitation are possible.
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Affiliation(s)
- Roman Evgenyevich Kalinin
- Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan 390026, Russia
| | - Igor Aleksandrovich Suchkov
- Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan 390026, Russia
| | - Nina Dzhansugovna Mzhavanadze
- Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan 390026, Russia
| | - Adelphina Felician Ncheye
- Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan 390026, Russia
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24
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Pasupathy S, Rodgers S, Tavella R, McRae S, Beltrame JF. Risk of Thrombosis in Patients Presenting with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA). TH OPEN 2018; 2:e167-e172. [PMID: 31249940 PMCID: PMC6524870 DOI: 10.1055/s-0038-1645875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/19/2018] [Indexed: 11/09/2022] Open
Abstract
Patients presenting with myocardial infarction (MI) in the absence of obstructive coronary artery disease (CAD) is termed MI with nonobstructive coronary arteries (MINOCA). The underlying pathophysiology of MINOCA is multifactorial and in situ formation and subsequent spontaneous lysis of a coronary thrombus is often hypothesized as one of the mechanisms. The objective of this study is to determine whether MINOCA patients had a greater prothrombotic tendency in comparison to MI patients with obstructive CAD (MICAD). Prospectively, blood samples of 25 consecutive MINOCA patients (58 (interquartile range [IQR]: 48, 75) years, 48% women) and 25 age-/gender-matched MICAD patients (58 (IQR: 50, 66) years, 48% women) were obtained at 1 month after the initial presentation and overall thrombin generation potential and congenital/acquired thrombophilia states were assessed. As regard to results, overall thrombin generation parameters were similar (
p
> 0.05) between the MINOCA and MICAD groups, highlighting similar endogenous thrombin potential (1,590 nM/min; IQR: 1,380, 2,000 vs. 1,750 nM/min; IQR: 1,500, 2,040, respectively). There were no significant differences between MINOCA and MICAD, respectively, in respect to the numbers of patients with congenital thrombophilia states including factor V Leiden (0 vs. 4%) and prothrombin gene mutation (8 vs. 4%), decreased antithrombin (8 vs. 0%), protein C (0 vs. 0%), and protein S (4 vs. 0%). None of the patients demonstrated presence of lupus anticoagulant and anticardiolipin antibodies. Although MINOCA patients revealed thrombotic characteristics that are similar to those with MICAD, the results from this study are inconclusive and a larger study with healthy control subjects is required to assess the risk of thrombosis in MINOCA.
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Affiliation(s)
- Sivabaskari Pasupathy
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Susan Rodgers
- Division of Hematology, SA Pathology, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Rosanna Tavella
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Simon McRae
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia.,Division of Hematology, SA Pathology, Adelaide, South Australia, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - John F Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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25
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Nordenskjöld AM, Baron T, Eggers KM, Jernberg T, Lindahl B. Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease. Int J Cardiol 2018; 261:18-23. [PMID: 29563017 DOI: 10.1016/j.ijcard.2018.03.056] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/17/2018] [Accepted: 03/12/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCAs) is an increasingly recognized entity. No previous study has evaluated predictors for new major adverse cardiacvascular events (MACEs) and death in patients with MINOCA. METHODS We conducted an observational study of MINOCA patients recorded between July 2003 and June 2013 and followed until December 2013 for outcome events. Out of 199,163 MI admissions, 9092 consecutive unique patients with MINOCA were identified. The mean age was 65.5 years and 62% were women. MACE was defined as all-cause mortality, rehospitalization for acute MI, ischemic stroke and heart failure. Hazard ratio and 95% confidence interval (HR; 95% CI) was calculated using Cox-regression. RESULTS A total of 2147 patients (24%) experienced a new MACE and 1254 patients (14%) died during the mean follow-up of 4.5 years. Independent predictors for MACE after adjustment, were older age (1.05; 1.04-1.06), diabetes (1.44; 1.21-1.70), hypertension (1.25; 1.09-1.43), current smoking (1.38; 1.15-1.66), previous myocardial infarction (1.38; 1.04-2.82), previous stroke (1.69; 1.35-2.11), peripheral vascular disease (1.55; 1.97-2.23), chronic obstructive pulmonary disease (1.63; 1.32-2.00), reduced left ventricular ejection fraction (2.00; 1.54-2.60), lower level of total cholesterol (0.88; 0.83-0.94) and higher level of creatinine (1.01; 1.00-1.03). Independent predictors for all cause death were age, current smoking, diabetes, cancer, chronic obstructive pulmonary disease, previous stroke, reduced left ventricular fraction, lower level of total cholesterol and higher levels of creatinine and CRP. CONCLUSIONS The clinical factors predicting new MACE and death of MINOCA patients seem to be strikingly similar to factors previously shown to predict new cardiovascular events in patients with MI and obstructive coronary artery disease.
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Affiliation(s)
- A M Nordenskjöld
- Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - T Baron
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - K M Eggers
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - T Jernberg
- Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - B Lindahl
- Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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26
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Safi M, Khaheshi I, Memaryan M, Naderian M. A Mysterious Case of ST-Elevation Myocardial Infarction; an Old Man with Weight Loss and Dyspepsia. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2017. [DOI: 10.21859/ijcp-030104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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27
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Marra MP, Zaninotto M, Cacciavillani L, Iliceto S, Plebani M. Massive Troponin Release and Normal Coronary Arteries: Where Does the Truth Lie? Clin Chem 2017; 63:1570-1573. [PMID: 28963131 DOI: 10.1373/clinchem.2016.264333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/20/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Martina P Marra
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital, Padova, Italy
| | - Luisa Cacciavillani
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital, Padova, Italy.
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Rallidis LS, Gialeraki A, Triantafyllis AS, Tsirebolos G, Liakos G, Moutsatsou P, Iliodromitis E. Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age with ST Segment Elevation Myocardial Infarction and "Normal or Near Normal" Coronary Arteries. Am J Cardiol 2017; 120:740-746. [PMID: 28689750 DOI: 10.1016/j.amjcard.2017.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/17/2017] [Accepted: 06/05/2017] [Indexed: 12/14/2022]
Abstract
There are scarce data regarding risk factors and prognosis of patients with premature ST segment elevation myocardial infarction (STEMI) and "normal or near normal" coronary arteries (N/NNCAs). We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs with their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age- and gender-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing <30% reduction in lumen diameter were defined as N/NNCAs, whereas narrowings causing ≥50% diameter reduction formed the significant CAD group. Lipid profile, homocysteine levels, and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism were determined. Sixty patients (18%) had N/NNCAs. Patients with N/NNCAs had lower low-density lipoprotein-cholesterol and higher high-density lipoprotein-cholesterol levels, higher homocysteine levels, and higher prevalence of MTHFR TT genotype (34.6 vs 18%, p = 0.008) compared with patients with significant CAD. After a median follow-up of 8 years, cardiovascular events occurred in 105 (36%) of 291 patients with available follow-up data. Significant CAD was associated with higher risk for recurrent cardiovascular events after adjustment for traditional risk factors (hazard ratio 2.095, 95% confidence interval 1.088 to 3.664, p = 0.022) and additional adjustment for the left ventricular ejection fraction, reperfusion therapy, and persistent smoking (hazard ratio 1.869, 95% confidence interval 1.007 to 3.468, p = 0.041). In conclusion, patients with premature STEMI and N/NNCAs have fewer lipid abnormalities, higher homocysteine levels and prevalence of MTHFR TT genotype, and better long-term prognosis compared with their counterparts with significant CAD.
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Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece.
| | - Argyri Gialeraki
- Laboratory of Hematology and Blood Transfusion Unit, University General Hospital Attikon, Athens, Greece
| | | | - Georgios Tsirebolos
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
| | - Georgios Liakos
- Biochemistry Laboratory, General Hospital of Nikea, Piraeus, Greece
| | - Paraskevi Moutsatsou
- Department of Clinical Biochemistry, University General Hospital Attikon, Athens, Greece
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Abstract
BACKGROUND Coronary artery anomalies are a heterogeneous group of congenital disorders presenting with a wide spectrum of symptoms, ranging from vague chest pain to sudden cardiac death. Despite available data, there is no consensus about the classification, nomenclature, and outcomes of coronary anomalies in the normally connected heart. In this study, we aimed to investigate clinical and angiographic characteristics of coronary arterial anomalies, as well as the frequency of atherosclerotic involvement in anomalous coronaries, diagnosed at a tertiary referral centre. METHODS We retrospectively reviewed coronary angiograms performed between 2011 and 2015 for the presence of a coronary anomaly. A total of 111 patients with a final diagnosis of coronary anomaly were included in the study group. We also recruited 110 age- and sex-matched patients who underwent coronary angiography because of symptomatic coronary artery disease as controls. RESULTS Among 36,893 coronary angiograms, 111 (0.30%) major coronary anomalies were found. Compared with controls, the prevalence of significant atherosclerotic coronary disease was lower in patients with coronary anomalies and stable symptoms (p=0.02); however, the prevalence of significant coronary atherosclerosis was similar among patients admitted with unstable angina or myocardial infarction (p>0.05). Compared with controls, patients with an anomalous left anterior descending coronary artery had significantly less atherosclerotic involvement than those in whom the left anterior descending artery was not anomalous (p=0.005). CONCLUSIONS Although coronary artery anomalies are cited as a cause for myocardial ischaemia, atherosclerotic coronary artery disease is also frequent and may offer an alternative explanation to ischaemic symptoms. No predisposition to accelerated atherosclerosis was found, however, and atherosclerotic involvement was less frequent in some anomalous vessels.
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Camastra GS, Sbarbati S, Danti M, Cacciotti L, Semeraro R, Della Sala SW, Ansalone G. Cardiac magnetic resonance in patients with acute cardiac injury and unobstructed coronary arteries. World J Radiol 2017; 9:280-286. [PMID: 28717414 PMCID: PMC5491655 DOI: 10.4329/wjr.v9.i6.280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/29/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To define the role of cardiac magnetic resonance (CMR) by analyzing a particular group of patients with suspected acute coronary syndrome (ACS) and normal coronary angiogram.
METHODS From January 2009 to December 2015, we examined 220 patients with clinical suspicion of ACS, Troponin elevation [the threshold used to define a positive Troponin T test (TnT) was 0.1 ng/mL] and no significant coronary disease at angiography (the patients were considered to have significant angiographic disease only a 50% stenosis was detected in any of their coronary arteries). The role of CMR with the late gadolinium enhancement was evaluated.
RESULTS CMR was performed to 190 patients (86%) of this group which reveals: Myocarditis in 90 patients (47%); apical ballooning (Tako-Tsubo syndrome) in 32 patients (17%); myocardial infarction (MI) in 40 patients (21%) and no clear diagnosis identified by CMR in 28 patients (15%). A comparison with previous studies was also made. Clinical and echocardiographic follow-ups were performed at 12 ± 2 mo and no major adverse cardiac events were revealed.
CONCLUSION There is a group of patients with clinical suspicion of ACS displaying normal coronary angiograms. CMR was demonstrated to be a valuable tool in the differential diagnosis evaluation of myocarditis, apical ballooning and MI.
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Barr PR, Harrison W, Smyth D, Flynn C, Lee M, Kerr AJ. Myocardial Infarction Without Obstructive Coronary Artery Disease is Not a Benign Condition (ANZACS-QI 10). Heart Lung Circ 2017; 27:165-174. [PMID: 28408093 DOI: 10.1016/j.hlc.2017.02.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/28/2016] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Non-obstructive coronary artery disease (CAD) on coronary angiography after myocardial infarction (MI) is associated with a lower risk of adverse outcomes, but the prognosis may not be benign. Our aim was to assess outcomes in MI with and without obstructive CAD, and in an age and sex matched comparison cohort without known cardiovascular disease. METHODS We performed a single centre analysis of consecutive patients undergoing coronary angiography for MI between 2007 and 2012. Patients were classified into those with obstructive CAD (≥50% epicardial coronary artery stenosis) and those without obstructive CAD (<50%). Myocardial infarction patient data was collected in an electronic registry and linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD were identified from the community PREDICT cohort. RESULTS Of the 2070 patients with MI, 302 (15%) had non-obstructive CAD. Compared to patients with obstructive disease they were younger (mean 57 v 61 years, p<0.001), more likely to be women (50% vs 23%, p<0.001), to be of Maori or Pacific vs. European ethnicity (p<0.001), more likely to be lifelong non-smokers (46% v 38%, p=0.02), non-diabetic (80v 73%, p <0.01), have no ST-segment deviation (78% v 46%, p<0.001), and have a low risk Global Registry of Acute Coronary Events acute coronary syndrome (GRACE ACS) score (54 v 35%, p<0.001). They were also less likely to receive 'triple therapy' secondary prevention medications (81% v 94%, p<0.0001). The cumulative two-year Kaplan-Maier composite outcome of mortality or non-fatal MI was 14.3% for MI with obstructive CAD, 4.6% for MI without obstructive disease, and 2.2% for patients without prior CVD (p<0.001). CONCLUSION Myocardial infarction without obstructive coronary disease is common (∼1 in 7 patients) and is not clinically benign, with an adverse outcome rate double that of age and sex matched patients without CVD.
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Affiliation(s)
- Peter R Barr
- Cardiology Department, Middlemore Hospital, Auckland, New Zealand.
| | - Wil Harrison
- Cardiology Department, Middlemore Hospital, Auckland, New Zealand
| | - David Smyth
- Cardiology Department, Christchurch Hospital, Christchurch, New Zealand
| | - Charmaine Flynn
- Cardiology Department, Middlemore Hospital, Auckland, New Zealand
| | - Mildred Lee
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Cardiology Department, Middlemore Hospital, Auckland, New Zealand; Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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Bière L, Niro M, Pouliquen H, Gourraud JB, Prunier F, Furber A, Probst V. Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction. World J Cardiol 2017; 9:268-276. [PMID: 28400924 PMCID: PMC5368677 DOI: 10.4330/wjc.v9.i3.268] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/27/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and non-obstructive coronary arteries (MINOCA) with normal ejection fraction (EF).
METHODS This is an observational analysis of 131 MINOCA patients with normal EF. Three cardiac magnetic resonance (CMR) diagnosis classes were recognized according to the late gadolinium enhancement (LGE) pattern: Myocardial infarction (MI) (n = 34), myocarditis (n = 47), and “no LGE” (n = 50). Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.
RESULTS Ventricular arrhythmia was observed in 18 (13.8%) patients during hospitalization. The “no LGE” patients experienced fewer ventricular events than the MI and myocarditis patients [4.0% vs 26.5% and 14.9%, respectively (P = 0.013)]. There was no significant difference between the MI and myocarditis groups. On multivariate analysis, LGE transmural extent [OR = 1.52 (1.08-2.15), P = 0.017] and ST-segment elevation [OR = 4.65 (1.61-13.40), P = 0.004] were independent predictors of ventricular arrhythmic events, irrespective of the diagnosis class. Finally, no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.
CONCLUSION MINOCA patients with normal EF presented no 1-year cardiovascular events, irrespective of the CMR diagnosis class. LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization.
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Di Bella G, Pingitore A, Piaggi P, Pizzino F, Barison A, Terrizzi A, d'angelo M, Todiere G, Quattrocchi S, Carerj S, Emdin M, Aquaro GD. Usefulness of late gadolinium enhancement MRI combined with stress imaging in predictive significant coronary stenosis in new-diagnosed left ventricular dysfunction. Int J Cardiol 2016; 224:337-342. [PMID: 27668708 DOI: 10.1016/j.ijcard.2016.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND To evaluate the accuracy of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) and imaging stress test in predicting significant coronary artery disease (CAD) in left ventricular (LV) dysfunction. METHODS We enrolled 187 consecutive out-patients (61±17years) with new evidence of depressed (<45%) ejection fraction and no history of previous heart diseases and absence of Q-waves. All patients underwent coronary angiography (CA) and to LGE-CMR examination to identify ischemic and non-ischemic LGE. All patients underwent stress imaging to determine the presence of myocardial ischemia. RESULTS Ischemic-LGE was found in 83 patients and non-ischemic-LGE in 104. Significant CAD on CA was found in 86/187 patients. Ischemic-LGE showed a specificity of 94%, a sensitivity of 89% and an accuracy of 92% in identifying significant CAD. Imaging stress test was negative in 98/105 patients without CAD, and positive in 42/82 with significant CAD, showing a specificity of 93%, a sensitivity of 51% and an accuracy of 75% in identifying CAD. Combining CMR and stress test imaging, 94 patients had ischemic-LGE pattern and/or positive stress test for ischemia; of these 81/94 had significant CAD on CA and 13 had no CAD. Among the 93 patients with both tests negative, significant CAD was found in 5/93 patients. The combination of LGE and stress respect to only LGE did not improve the diagnostic accuracy (90 vs 92% respectively). CONCLUSION LGE-CMR had high accuracy in predicting significant CAD in ischemic LV dysfunction or as a bystander in non ischemic dysfunction.
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Affiliation(s)
- Gianluca Di Bella
- CNR, Institute of Clinical Physiology, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | | | - Paolo Piaggi
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fausto Pizzino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Barison
- Fondazione Toscana G. Monasterio, CNR - Regione Toscana, Pisa, Italy
| | - Anna Terrizzi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Miriam d'angelo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giancarlo Todiere
- Fondazione Toscana G. Monasterio, CNR - Regione Toscana, Pisa, Italy
| | - Salvina Quattrocchi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Emdin
- Fondazione Toscana G. Monasterio, CNR - Regione Toscana, Pisa, Italy
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The fundamental importance of smoking cessation in those with premature ST-segment elevation acute myocardial infarction. Curr Opin Cardiol 2016; 31:531-6. [DOI: 10.1097/hco.0000000000000320] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Fama' F, Dattola V, Cicciu' M, Buccafusca M, Russo M, Lo Presti D, Dattilo G, Di Bella G. Natalizumab treatment for multiple sclerosis inducing a toxic acute myocardial damage. Is there any relationship? Int J Cardiol 2016; 206:127-8. [PMID: 26788687 DOI: 10.1016/j.ijcard.2016.01.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/02/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Fausto Fama'
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy.
| | - Vincenzo Dattola
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy
| | - Marco Cicciu'
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy
| | - Maria Buccafusca
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy
| | | | - Dario Lo Presti
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via Consolare Valeria n.1, 98125 Messina, Italy
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Jain S, Sarkar NC, Sarkar P, Modi N, Tilkar M. Evaluation of Coronary Artery Status by Coronary Angiography after First Survival of Acute Myocardial Infarction. J Clin Diagn Res 2016; 9:OC06-8. [PMID: 26816930 DOI: 10.7860/jcdr/2015/16502.6887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/28/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute Myocardial Infarction (AMI) is a life threatening medical emergency which needs urgent medical attention. It is one of the major cause of mortality and morbidity throughout the world. AIM The aim of the present study was to assess the coronary artery status by Coronary Angiography (CAG) after first survival of the Acute Myocardial Infarction (AMI) and to correlate the CAG findings with Coronary Artery Disease (CAD) Risk Factor (RF) and effect of early thrombolysis. MATERIALS AND METHODS CAG was done on 870 patients consecutively from June 2013 to May 2015. Age, Gender, Body Mass Index (BMI), CAD risk factors (RF) such as Type 2 diabetes mellitus (T2 DM), hypertension, dyslipidaemia, smoking status and history of thrombolyctic status were recorded. The correlation between the CAD risk factors (RF) and the CAG findings were statistically analyzed. RESULTS Coronary heart disease risk factors analysis revealed ≥ three RF in 23.88%, two RF in 29.88% and one RFin 45.86% of patients. CAG showed Single Vessel Disease (SVD) in 236 (27.1%) patients, double vessel disease (DVD) in 220(25.2%) patients, Triple Vessel Disease (TVD) in 252 (28.9%) patients. Multiple coronary artery involvement were found in the high risk group patients, which was found statistically significant (p-value<0.0001). A total of 348/870 (40%) patients were thrombolysed amongst them 80 (22.9%) revealed minimal and/or normal coronary artery which was found statistically significant (p-value<0.0001). CONCLUSION Higher the coronary risk factors, more the chance of the multiple coronary arteries involvement. All AMI patients should be thrombolysed as early as possible to get the benefit of recanalization of the culprit vessel.
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Affiliation(s)
- Siddhant Jain
- Associate Professor, Department of Cardiology, Sri Aurobindo Medical College and PG Institute , Indore, MP, India
| | - Narayan Chandra Sarkar
- Associate Professor, Department of Cardiology, Sri Aurobindo Medical College and PG Institute , Indore, MP, India
| | - Piyabi Sarkar
- Post Graduate Resident, Department of Pathology, Institute of Post Graduate Medical Education and Research and SSKM Hosptial , Kolkata, WB, India
| | - Nitin Modi
- Interventional Cardiologist, CHL-Apollo Hospital , Indore, MP, India
| | - Mahendra Tilkar
- Assistant Professor, Department of Medicine, Sri Aurobindo Medical College and PG Institute , Indore, MP, India
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Zhang S, Yang J, Jin X, Zhang S. Myocardial infarction, symptomatic third degree atrioventricular block and pulmonary embolism caused by thalidomide: a case report. BMC Cardiovasc Disord 2015; 15:173. [PMID: 26681197 PMCID: PMC4683955 DOI: 10.1186/s12872-015-0164-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/04/2015] [Indexed: 12/21/2022] Open
Abstract
Background Thalidomide has been reported to cause numerous thromboembolic events. Deep vein thrombosis and pulmonary embolism are more common. It can also cause bradycardia and even total atrioventricular block. Rarely, it causes coronary artery spasm and even myocardial infarction. But almost simultaneous onset of myocardial infarction, third degree atrioventricular block and pulmonary embolism in one patient has not been reported so far. Case presentation A 53-year old man presented because of chest pain, nausea and then syncope for several minutes. Previous medical history included neurodermitis for which thalidomide was given and hypercholesterolemia with simvastatin taking. The patient didn’t exhibit any other established risk factors for coronary artery disease. Electrocardiography showed sinus rhythm with third degree atrioventricular block and complete right bundle branch block, and precordial leads ST segment elevation. The diagnosis of acute coronary syndrome was suspected, but further coronary angiography demonstrated no flow-limiting lesions in coronary arteries, and temporary pacemaker was implanted. After admission, low SpO2 and elevated D-dimer level was mentioned. Further computed tomography pulmonary angiography revealed pulmonary embolism. Thalidomide was thought to be the cause of hypercoagulability and coronary spasm, so it was ceased immediately. Therapeutic low molecule weight heparin was initiated and then switched to warfarin with appropriate INR, and nifedipine was described for coronary spasm. The patient’s symptoms completely relived and SpO2 recovered, and atrioventricular block had disappeared during hospitalization with pacemaker removed. Conclusion This is the very first case in which myocardial infarction, third degree atrioventricular block and pulmonary embolism almost simultaneously developed. We should be ware that anti-thrombotic prophylaxis, which needs further investigation for optimal drug and dosage, may be beneficial in thalidomide therapy. And it is also important to monitor patients taking thalidomide for signs and symptoms of bradycardia or higher degree atrioventricular block.
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Affiliation(s)
- Shengyu Zhang
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Jing Yang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Xiaofeng Jin
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Brolin EB, Brismar TB, Collste O, Y-Hassan S, Henareh L, Tornvall P, Cederlund K. Prevalence of Myocardial Bridging in Patients With Myocardial Infarction and Nonobstructed Coronary Arteries. Am J Cardiol 2015; 116:1833-9. [PMID: 26506121 DOI: 10.1016/j.amjcard.2015.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 01/30/2023]
Abstract
Mechanisms of acute myocardial infarction and nonobstructed coronary arteries (MINOCA) are incompletely understood. Myocardial bridging (MB) is usually considered a benign congenital variant, but serious complications have been reported. MB has also been proposed as a cause of takotsubo syndrome (TS). We aimed to examine whether MB was more frequent in patients with MINOCA or TS than in age- and gender-matched controls and to compare the MB detection rates of coronary computed tomography angiography (CTA) and invasive coronary angiography (ICA). Patients with MINOCA (n = 57) and age- and gender-matched controls (n = 58), aged 45 to 70 were enrolled. Myocarditis was excluded by cardiovascular magnetic resonance imaging. Patients with TS (n = 15) were considered as a subgroup and therefore not excluded. Patients with MINOCA underwent ICA and all study participants underwent coronary CTA. All examinations were reviewed with focus on MB. Among 57 MINOCA patients, 15 MINOCA patients with TS and 58 controls, MB was demonstrated in 28 patients (49%), 8 patients (53%), and 26 patients (45%), respectively. There were no statistically significant differences regarding the prevalence of MB or the type, location, length, or thickness of MB. There was a statistically significant difference (p <0.01) between the detection rates of coronary CTA and ICA that demonstrated MB in 54 subjects (47%) and 13 subjects (23%), respectively. In conclusion, MB was frequent with a similar prevalence in patients with MINOCA, patients with TS and controls. This suggests that there is no causal link between MB and MINOCA or TS. Furthermore, coronary CTA detects MB at a significantly higher rate than ICA.
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Affiliation(s)
- Elin B Brolin
- Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden; Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Torkel B Brismar
- Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden; Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olov Collste
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Shams Y-Hassan
- Department of Cardiology, Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital Huddinge and Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Cederlund
- Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden; Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Halna du Fretay X, Dibon O, Naël J. [Acute coronary syndromes with ST elevation and angiographically normal culprit coronary arteries: Case report and update]. Ann Cardiol Angeiol (Paris) 2015; 64:505-12. [PMID: 26525680 DOI: 10.1016/j.ancard.2015.09.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute coronary syndrome results in most cases of atherosclerotic plaque rupture. In a few cases, the physiopathological mechanism is different. This does not necessarily change the initial strategy but the subsequent treatments. We report three cases of clinical presentations of acute coronary syndrome whose pathophysiological mechanism is not or not mainly due to atherosclerotic lesions. Based on these cases and a review of the literature, two topics will be tackled: the diagnostic and therapeutic strategy in the management of Tako-tsubo cardiomyopathies and also acute coronary syndromes due to vasospastic angina.
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Affiliation(s)
- X Halna du Fretay
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Service de cardiologie, centre hospitalier universitaire Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Service de cardiologie, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans, France.
| | - O Dibon
- Service de cardiologie, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans, France
| | - J Naël
- Service de cardiologie, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans, France
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Daniel M, Ekenbäck C, Agewall S, Brolin EB, Caidahl K, Cederlund K, Collste O, Eurenius L, Frick M, Younis-Hassan S, Henareh L, Jernberg T, Malmqvist K, Spaak J, Sörensson P, Hofman-Bang C, Tornvall P. Risk Factors and Markers for Acute Myocardial Infarction With Angiographically Normal Coronary Arteries. Am J Cardiol 2015; 116:838-44. [PMID: 26251000 DOI: 10.1016/j.amjcard.2015.06.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/06/2015] [Accepted: 06/06/2015] [Indexed: 12/15/2022]
Abstract
Myocardial Infarction with normal coronary arteries (MINCA) is common with a prevalence of 1% to 12% of all myocardial infarctions. The pathogenic mechanisms of MINCA are still unknown, but endothelial dysfunction has been suggested as a possible cause. To investigate risk factors and markers for MINCA, we conducted a case-control study. Considering the reported low prevalence of classical risk factors for coronary heart disease (CHD) in some but not all studies, our hypothesis was that endothelial function and intima-media thickness (IMT) were better, respectively lower, than CHD controls. One hundred patients with MINCA fulfilling diagnostic criteria according to the European Society of Cardiology/American Collage of Cardiology/American Heart Association universal definition of myocardial infarction with myocarditis excluded by cardiac magnetic resonance imaging were investigated. Risk factors, endothelial function (EndoPAT), and IMT were compared to gender- and age-matched patients with myocardial infarction and CHD, respectively healthy controls. Smoking, hypertension, impaired glucose tolerance and diabetes mellitus, inflammatory disease, and psychiatric disorders were more common in patients with MINCA than in healthy controls. In contrast to patients with CHD, the lipid profile was antiatherogenic with low low-density lipoprotein and high high-density lipoprotein cholesterol. There were no major differences between the groups regarding endothelial function and IMT that were in the normal range. In conclusion, the present study showed that MINCA was associated with many established cardiovascular risk factors without major differences in atherosclerosis markers. MINCA patients recalled a high prevalence of emotional stress before admission that together with previous psychiatric vulnerability and female gender speaks strongly in favor of Takotsubo syndrome being an important cause of MINCA.
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Affiliation(s)
- Maria Daniel
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Medicine Clinic, Department of Cardiology, Capio S:t Göran Hospital, Stockholm, Sweden.
| | - Christina Ekenbäck
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Agewall
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Institute of Clinical Medicine, Department of Cardiology, University of Oslo, Oslo, Norway
| | - Elin B Brolin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Cederlund
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olov Collste
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Lars Eurenius
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | | | - Loghman Henareh
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Karin Malmqvist
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peder Sörensson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Dastidar AG, Rodrigues JCL, Ahmed N, Baritussio A, Bucciarelli-Ducci C. The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015; 8:28. [PMID: 26146527 PMCID: PMC4483181 DOI: 10.1007/s12410-015-9345-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity worldwide. Seven to fifteen percent of patients presenting with ACS have unobstructed coronary artery disease (CAD) on urgent angiography. Patients with ACS and unobstructed coronary arteries represent a clinical dilemma and their diagnosis and management is quite variable in current practice. Cardiovascular magnetic resonance imaging with its unique non-invasive myocardial tissue characterization property has the potential to identify underlying etiologies and reach a final diagnosis. These include acute and chronic myocarditis, embolic/spontaneous recanalization myocardial infarction, and Tako-Tsubo cardiomyopathy, and other conditions. Establishing a final diagnosis has a direct implication on patient's management and prognosis. In this article, we have reviewed the current evidence on the diagnostic role of cardiac magnetic resonance (CMR) in patients with ACS and unobstructed coronary arteries. We have also highlighted the potential role of CMR as a risk stratification or prognostication tool for this patient population.
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Affiliation(s)
- Amardeep Ghosh Dastidar
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK
| | - Jonathan C. L. Rodrigues
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK
| | - Nauman Ahmed
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK
| | - Anna Baritussio
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK
| | - Chiara Bucciarelli-Ducci
- NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK
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Chacón-Hernández N, San Miguel-Cervera D, Vilar-Herrero JV, Rumiz-González E, Berenguer-Jofresa A, Morell-Cabedo S. Acute Coronary Syndrome in Patients With Normal Coronary Arteries: An Optical Coherence Tomography Study. ACTA ACUST UNITED AC 2015; 68:533-5. [DOI: 10.1016/j.rec.2015.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/30/2015] [Indexed: 11/15/2022]
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Síndrome coronario agudo en pacientes con arterias coronarias normales: estudio con tomografía de coherencia óptica. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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44
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Tornvall P, Gerbaud E, Behaghel A, Chopard R, Collste O, Laraudogoitia E, Leurent G, Meneveau N, Montaudon M, Perez-David E, Sörensson P, Agewall S. Myocarditis or "true" infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data. Atherosclerosis 2015; 241:87-91. [PMID: 25967935 DOI: 10.1016/j.atherosclerosis.2015.04.816] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) is common, but the causes are to a large extent unknown. Thus, we aimed to study the prevalence of myocarditis and "true" myocardial infarction determined by cardiac magnetic resonance (CMR) imaging in MINOCA patients, and risk markers for these two conditions in this population. METHODS A search was made in the PubMed and Cochrane databases using the search terms "Myocardial infarction", "Coronary angiography", "Normal coronary arteries" and "MRI". All relevant abstracts were read and seven of the studies fulfilled the inclusion criteria; studies describing case series of patients fulfilling the diagnosis of acute myocardial infarction with normal or non-obstructive coronary arteries on coronary angiography that were investigated with CMR imaging. Data from five of these studies are presented. RESULTS A total of 556 patients from 5 different sites were included. Fifty-one percent were men with a mean age of 52 ± 16 years. Thirty-three per cent of the patients had myocarditis (n = 183), whereas 21% of the patients had infarction on CMR (n = 115). Young age and a high CRP were associated with myocarditis whereas male sex, treated hyperlipidemia, high troponin ratio and low CRP were associated with "true" myocardial infarction. CONCLUSION AND RELEVANCE The results of this meta-analysis of individual data showed that myocarditis and "true" myocardial infarction are common in MINOCA when determined by CMR imaging. This information emphasizes the importance of performing CMR imaging in MINOCA patients and can be used clinically to guide diagnostics and treatment of MINOCA patients.
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Affiliation(s)
- P Tornvall
- Cardiology Unit, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sweden.
| | - E Gerbaud
- Soins Intensifs Cardiologiques, Plateau de Cardiologie Interventionnelle, CHU de Bordeaux, Hôpital du Haut Lévêque, 5 Avenue de Magellan, F33604 Pessac, France
| | - A Behaghel
- CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, INSERM, U1099, Université de Rennes 1, LTSI, Rennes, France
| | - R Chopard
- Department of Cardiology, EA 3920, University Hospital Jean Minjoz, 25000 Besancon, France
| | - O Collste
- Cardiology Unit, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sweden
| | | | - G Leurent
- CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, INSERM, U1099, Université de Rennes 1, LTSI, Rennes, France
| | - N Meneveau
- Department of Cardiology, EA 3920, University Hospital Jean Minjoz, 25000 Besancon, France
| | - M Montaudon
- Unité d'Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Hôpital du Haut Lévêque, 5 Avenue de Magellan, F33604 Pessac, France
| | | | - P Sörensson
- Cardiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Sweden
| | - S Agewall
- Department of Cardiology, Oslo University Hospital Ullevål, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zaĭrat'iants OV, Mishnev OD, Kakturskiĭ LV. [Myocardial infarction and acute coronary syndrome: definitions, classification, and diagnostic criteria]. Arkh Patol 2015; 76:3-11. [PMID: 25842920 DOI: 10.17116/patol20147663-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The review gives the definitions and classification of and diagnostic criteria for myocardial infarction and acute coronary syndrome in accordance with the "The third universal definition of myocardial infarction" adopted in 2012 (Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, 2012). It also discusses the clinical and morphological comparisons of and the problems in the differential diagnosis of myocardial infarction as a nosological entity within coronary heart disease with other coronarogenic and non-coronarogenic necroses of the myocardium.
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Affiliation(s)
- O V Zaĭrat'iants
- Kafedra patologicheskoĭ anatomii GBOU VPO "Moskovskiĭ gosudarstvennyĭ mediko-stomatologicheskiĭ universitet im. A.I. Evdokimova" Minzdrava Rossii
| | - O D Mishnev
- FGBU "NII morfologii cheloveka RAMN", Moskva, Rossiĭskaia Federatsiia
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46
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Mallouppas M, Christopoulos C, Watson W, Cader R, Cooper J. An uncommon complication of atrial fibrillation. Oxf Med Case Reports 2015; 2015:232-4. [PMID: 27559478 PMCID: PMC4994762 DOI: 10.1093/omcr/omv017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 11/24/2022] Open
Abstract
Coronary embolism is a well-recognized cause of myocardial infarction. It is often under diagnosed and cardiologists need to be vigilant for this diagnosis. A 77-year-old man presented with chest pain with an ECG showing a new diagnosis of atrial fibrillation. Owing to ongoing chest pain coronary angiography was performed and revealed an acute occlusion of the left circumflex artery with coronary blood flow restored following aspiration of a large red thrombus. Following this the coronary vessel looked smooth with no residual coronary lesions requiring angioplasty or plaque rupture to justify the thrombosis. The clinical picture and angiographic data suggested the coronary embolus was secondary to the newly diagnosed atrial fibrillation.
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Affiliation(s)
| | | | - Will Watson
- Cardiology Department , Bedford General Hospital , Bedford , UK
| | - Ruzaika Cader
- Cardiology Department , Bedford General Hospital , Bedford , UK
| | - John Cooper
- Cardiology Department , Bedford General Hospital , Bedford , UK
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47
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Martinez JD, Babu RV, Sharma G. Case Report:Escherichia coliSeptic Shock Masquerading as ST-Segment Elevation Myocardial Infarction. Postgrad Med 2015; 121:102-5. [DOI: 10.3810/pgm.2009.03.1981] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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48
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Rallidis LS, Sakadakis EA, Tympas K, Varounis C, Zolindaki M, Dagres N, Lekakis J. The impact of smoking on long-term outcome of patients with premature (≤35years) ST-segment elevation acute myocardial infarction. Am Heart J 2015; 169:356-62. [PMID: 25728725 DOI: 10.1016/j.ahj.2014.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are few data regarding the long-term prognosis of young survivors of acute myocardial infarction (AMI). We explored the long-term outcome in individuals who had sustained a premature ST-segment elevation AMI. METHODS We recruited 257 consecutive patients who had survived their first AMI ≤35years of age. Patients were followed up for up to 18years. Clinical end points included all major adverse coronary events (MACE): cardiac death, readmission for acute coronary syndrome, arrhythmias, or coronary revascularization due to clinical deterioration. RESULTS The most prevalent risk factor at presentation was smoking (93.7%). Follow-up data were obtained from 237 patients (32.2±3.7years old). The median follow-up period was 9.1years. During follow-up, 139 (58.6%) patients reported continuation of smoking. Ninety-one (38.4%) patients had recurrent MACE (13 deaths, 59 acute coronary syndromes, 2 arrhythmias, and 17 revascularizations). Multivariable Cox regression analysis showed that persistence of smoking, left ventricular ejection fraction (LVEF), and reperfusion therapy (fibrinolysis or primary coronary angioplasty) were independent predictors of MACE after adjustment for conventional risk factors. Continuation of smoking remained an independent predictor for MACE after additional adjustments for LVEF (hazard ratio 2.154, 95% CI 1.313-3.535, P=.002) or reperfusion treatment (hazard ratio 2.327, 95% CI 1.423-3.804, P=.001). Harrell c statistic showed that the model with persistent smoking had the best discriminatory power compared with models with LVEF or reperfusion treatment. CONCLUSIONS In the era of statins and reperfusion treatment, continuation of smoking is the strongest independent long-term predictor for recurrent MACE in young survivors of premature AMI.
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Acetylcholine-induced coronary spasm in patients with unobstructed coronary arteries is associated with elevated concentrations of soluble CD40 ligand and high-sensitivity C-reactive protein. Coron Artery Dis 2015; 26:126-32. [DOI: 10.1097/mca.0000000000000181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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50
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Kawecki D, Morawiec B, Monney P, Pellaton C, Wojciechowska C, Jojko J, Basiak M, Przywara-Chowaniec B, Fournier S, Nowalany-Kozielska E, Schwitter J, Muller O. Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms. Med Sci Monit 2015; 21:171-80. [PMID: 25604184 PMCID: PMC4345916 DOI: 10.12659/msm.892296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/23/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In spite of robust knowledge about underlying ischemic myocardial damage, acute coronary syndromes (ACS) with culprit-free angiograms raise diagnostic concerns. The present study aimed to evaluate the additional value of cardiac magnetic resonance (CMR) over commonly available non-CMR standard tests, for the differentiation of myocardial injury in patients with ACS and non-obstructed coronary arteries. MATERIAL/METHODS Patients with ACS, elevated hs-TnT, and a culprit-free angiogram were prospectively enrolled into the study between January 2009 and July 2013. After initial evaluation with standard tests (ECG, echocardiography, hs-TnT) and provisional exclusion of acute myocardial infarction (AMI) in coronary angiogram, patients were referred for CMR with the suspicion of myocarditis or Takotsubo cardiomyopathy (TTC). According to the result of CMR, patients were reclassified as having myocarditis, AMI, TTC, or non-injured myocardium as assessed by late gadolinium enhancement. RESULTS Out of 5110 patients admitted with ACS, 75 had normal coronary angiograms and entered the study; 69 of them (92%) were suspected for myocarditis and 6 (8%) for TTC. After CMR, 49 patients were finally diagnosed with myocarditis (65%), 3 with TTC (4%), 7 with AMI (9%), and 16 (21%) with non-injured myocardium. The provisional diagnosis was changed or excluded in 23 patients (31%), with a 9% rate of unrecognized AMI. CONCLUSIONS The study results suggest that the evaluation of patients with ACS and culprit-free angiogram should be complemented by a CMR examination, if available, because the initial work-up with non-CMR tests leads to a significant proportion of misdiagnosed AMI.
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Affiliation(s)
- Damian Kawecki
- 2 Department of Cardiology, Silesian Medical University, Zabrze, Poland
| | - Beata Morawiec
- 2 Department of Cardiology, Silesian Medical University, Zabrze, Poland
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, University Hospital, Lausanne, Switzerland
- Center of Cardiac Magnetic Resonance, University Hospital, Lausanne, Switzerland
| | - Cyril Pellaton
- Department of Cardiology, University Hospital, Lausanne, Switzerland
- Center of Cardiac Magnetic Resonance, University Hospital, Lausanne, Switzerland
| | | | - Joanna Jojko
- 2 Department of Cardiology, Silesian Medical University, Zabrze, Poland
| | - Marcin Basiak
- Department of Internal Medicine and Clinical Pharmacology, Silesian Medical University, Katowice, Poland
| | | | - Stephane Fournier
- Department of Cardiology, University Hospital, Lausanne, Switzerland
| | | | - Juerg Schwitter
- Department of Cardiology, University Hospital, Lausanne, Switzerland
- Center of Cardiac Magnetic Resonance, University Hospital, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital, Lausanne, Switzerland
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