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Fan HP, Rui JQ, Xin CX, Zhou Y, Jin J, Hu XF. Medium-Term Prognostic Implications of Cardiac Magnetic Resonance Imaging in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): A Systematic Review and Meta-Analysis. Heart Lung Circ 2023; 32:1334-1346. [PMID: 37919116 DOI: 10.1016/j.hlc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the medium-term prognostic implications of cardiac magnetic resonance (CMR) imaging in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA). METHODS A systematic literature search of Embase, PubMed, and The Cochrane Library was performed. Eligible studies reported outcomes of CMR-assessed MINOCA with a mean follow-up period of >6 months. The primary endpoint was all-cause death. Secondary endpoints included cardiac death, reinfarction, and cardiovascular rehospitalisation. The pooled effect sizes with 95% confidence interval (CIs) were estimated using a random effect model. RESULTS A total of 3,050 patients from twenty-one studies were included in the meta-analysis. The prevalence of myocarditis, "true" myocardial infarction, Takotsubo cardiomyopathy, and normal CMR imaging was 36%, 25%, 14%, and 19%, respectively. Pooled data showed that the annualised event rates for all-cause mortality, cardiac mortality, reinfarction, and cardiovascular rehospitalisation were 1.01% (95% CI 0.59%-1.51%), 0.06% (95% CI 0.00%-0.39%), 0.68% (95% CI 0.18%-1.38%), and 5.67% (95% CI 3.11%-8.85%), respectively. Compared with patients with a diagnosis of myocarditis on CMR, patients with Takotsubo cardiomyopathy (RR 7.11; 95% CI 3.04-16.66) and "true" myocardial infarction (RR 3.82; 95% CI 1.65-8.86) were associated with a significantly higher risk of all-cause mortality, whereas a similar risk of all-cause mortality was observed in patients with normal imaging (RR 1.01; 95% CI 0.28-3.59). No association was found between CMR diagnoses and the risk of secondary endpoints in MINOCA. CONCLUSIONS In patients with MINOCA assessed by CMR, the overall absolute incidence rates of mortality and reinfarction were low. However, certain imaging diagnoses were associated with a higher risk of all-cause mortality, with most deaths attributed to non-cardiac causes. Additionally, these patients experienced a high burden of cardiovascular rehospitalisation. REGISTRATION PROSPERO (CRD42022323615).
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Affiliation(s)
- Hua-Ping Fan
- Department of Cardiology, 63650 Military Hospital, Urumqi, China
| | - Jian-Qiao Rui
- Department of Internal Medicine, Jingxi Medical District, PLA General Hospital, Beijing, China
| | - Chen-Xi Xin
- School of International Education, Xinxiang Medical University, Xinxiang, China
| | - Yu Zhou
- Department of Cardiology, 63650 Military Hospital, Urumqi, China
| | - Jun Jin
- Institute of Cardiovascular Diseases, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiao-Fei Hu
- Department of Nuclear Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
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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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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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The evolving role of cardiac imaging in patients with myocardial infarction and non-obstructive coronary arteries. Prog Cardiovasc Dis 2021; 68:78-87. [PMID: 34600948 DOI: 10.1016/j.pcad.2021.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/29/2021] [Indexed: 01/02/2023]
Abstract
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical conundrum accounting for about 6%-8% of all acute MI who are referred for coronary angiography. Current guidelines and consensus documents recommend that these patients are appropriately diagnosed, uncovering the causes of MINOCA, so that specific therapies can be prescribed. Indeed, there are a variety of causes that can result in this clinical condition, and for this reason diagnostic cardiac imaging has an emerging critical role in the assessment of patients with suspected or confirmed MINOCA. In last years, different cardiac imaging techniques have been evaluated in this context, and the comprehension of their strengths and limitations is of the utmost importance for their effective use in clinical practice. Moreover, recent evidence is clearly suggesting that a multimodality cardiac imaging approach, combining different techniques, seems to be crucial for a proper management of MINOCA. However, great variability still exists in clinical practice in the management of patients with suspected MINOCA, also depending on the availability of diagnostic tools and local expertise. Herein, we review the current knowledge supporting the use of different cardiac imaging techniques in patients with MINOCA, underscoring the importance of a comprehensive multimodality cardiac imaging approach and proposing a practical diagnostic algorithm to properly identify and treat the specific causes of MINOCA, in order to improve prognosis and the quality of life in these patients.
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Vicente-Ibarra N, Feliu E, Bertomeu-Martínez V, Cano-Vivar P, Carrillo-Sáez P, Morillas P, Ruiz-Nodar JM. Role of cardiovascular magnetic resonance in the prognosis of patients with myocardial infarction with non-obstructive coronary arteries. J Cardiovasc Magn Reson 2021; 23:83. [PMID: 34193204 PMCID: PMC8247260 DOI: 10.1186/s12968-021-00773-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is estimated that 5% to 10% of patients with myocardial infarction (MI) present with no obstructive coronary artery lesions. Until now, most studies have focused on acute coronary syndrome, including different clinical entities with a similar presentation encompassed under the term MINOCA (MI with non-obstructive coronary arteries). The aim of this study is to assess the prognosis of patients diagnosed with true infarction, confirmed by cardiovascular magnetic resonance (CMR), in the absence of significant coronary lesions. METHODS Prospective multicenter registry study, including 120 consecutive patients with a CMR-confirmed MI without obstructive coronary artery lesions. The primary clinical outcome was major adverse cardiovascular events (MACE: death, non-fatal infarction, stroke, or cardiac readmission), assessed over three years. RESULTS Seventy-six patients (63.3%) were admitted with a diagnosis of acute coronary syndrome, and 44 (36.6%) for other causes (mainly heart failure); the definitive diagnosis was established by CMR. Most patients (64.2%) were men, and the mean age was 58.8 ± 13.5 years. Patients presented with small infarcts: 83 (69.1%) showed late gadolinium enhancement (LGE) in one or two myocardial segments, mainly transmural (in 77.5% of patients) and with a preserved left ventricular ejection fraction (median 54.8%, interquartile range 37-62). The most frequent infarct location was inferolateral (n = 38, 31.7%). During follow-up, 43 patients (35.8%) experienced a MACE, including 9 (7.5%) who died. In multivariable analysis, LGE in two versus one myocardial segment doubled the risk of adverse cardiac events (hazard ratio [HR] 2.32, 95% confidence interval [CI] 0.97-5.83, p = 0.058). Involvement of three or more myocardial segments almost tripled the risk (HR 2.71, 95% CI 1.04-7.04, p = 0.040 respectively). CONCLUSIONS Patients with true MI but without significant coronary artery lesions predominantly had small infarcts. Myocardial 3-segment LGE involvement is associated with a significantly higher risk of adverse cardiac events.
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Affiliation(s)
| | - Eloisa Feliu
- Magnetic Resonance Imaging Unit, Inscanner S.L. General University Hospital of Alicante, Alicante, Spain
| | | | - Pedro Cano-Vivar
- Cardiology Service. Santa Lucía General University Hospital. Cartagena, Murcia, Spain
| | | | - Pedro Morillas
- Cardiology Service, Elche University Hospital, Alicante, Spain
| | - Juan Miguel Ruiz-Nodar
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), General University Hospital of Alicante, Alicante, Spain
- Department of Cardiology, General University Hospital of Alicante, Alicante, Spain
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Schaaf M, Croisille P, Py A, Roubille F, Biere L, Bochaton T, Perret T, Belle L, De Poli F, Hovasse T, Lairez O, Boussaha I, Rioufol G, Prunier F, Ovize M, Mewton N. Non-culprit artery myocardial infarction and complex coronary lesions in anterior ST-elevated myocardial infarction patients. Cardiology 2021; 146:728-736. [PMID: 34348264 DOI: 10.1159/000518137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Mathieu Schaaf
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Pierre Croisille
- Radiology Department, Hôpital Nord, CHU Saint-Etienne, Saint Etienne, France
| | - Agathe Py
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Fédération de Cardiologie, Hospices Civils de Lyon, Lyon, France
| | - François Roubille
- Cardiology Department, Hôpital Arnaud de Villeuneuve, CHU de Montpellier, Montpellier, France
| | - Loic Biere
- Cardiology Department, CHU d'Angers, Angers, France
| | - Thomas Bochaton
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Thibault Perret
- Cardiology Department, Centre Hospitalier, St Joseph Saint Luc, Lyon, France
| | - Loic Belle
- Cardiology Department, Centre Hospitalier d'Annecy, Annecy, France
| | | | - Thomas Hovasse
- Cardiology Department, Jacques Cartier Institute, Massy, France
| | - Olivier Lairez
- Cardiology Department, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Inesse Boussaha
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Gilles Rioufol
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | | | - Michel Ovize
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- CHU de Lyon, Hôpital Cardiovasculaire Louis Pradel, Centre d'Investigation Clinique, INSERM 1407, Hospices Civils de Lyon, Lyon, France
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Golpour A, Patriki D, Hanson PJ, McManus B, Heidecker B. Epidemiological Impact of Myocarditis. J Clin Med 2021; 10:603. [PMID: 33562759 PMCID: PMC7915005 DOI: 10.3390/jcm10040603] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Myocarditis is an inflammatory disease of the heart muscle with a wide range of potential etiological factors and consequently varying clinical patterns across the world. In this review, we address the epidemiology of myocarditis. Myocarditis was considered a rare disease until intensified research efforts in recent decades revealed its true epidemiological importance. While it remains a challenge to determine the true prevalence of myocarditis, studies are underway to obtain better approximations of the proportions of this disease. Nowadays, the prevalence of myocarditis has been reported from 10.2 to 105.6 per 100,000 worldwide, and its annual occurrence is estimated at about 1.8 million cases. This wide range of reported cases reflects the uncertainty surrounding the true prevalence and a potential underdiagnosis of this disease. Since myocarditis continues to be a significant public health issue, particularly in young adults in whom myocarditis is among the most common causes of sudden cardiac death, improved diagnostic and therapeutic procedures are necessary. This manuscript aims to summarize the current knowledge on the epidemiology of myocarditis, new diagnostic approaches and the current epidemiological impact of the COVID-19 pandemic.
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Affiliation(s)
- Ainoosh Golpour
- Campus Benjamin Franklin, Charite Universitätsmedizin Berlin, 12203 Berlin, Germany;
| | - Dimitri Patriki
- Department of Medicine, Cantonal Hospital of Baden, 15005 Baden, Switzerland;
| | - Paul J. Hanson
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC V5K0A1, Canada; (P.J.H.); (B.M.)
| | - Bruce McManus
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC V5K0A1, Canada; (P.J.H.); (B.M.)
| | - Bettina Heidecker
- Campus Benjamin Franklin, Charite Universitätsmedizin Berlin, 12203 Berlin, Germany;
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Vágó H, Szabó L, Dohy Z, Czimbalmos C, Tóth A, Suhai FI, Bárczi G, Gyarmathy VA, Becker D, Merkely B. Early cardiac magnetic resonance imaging in troponin-positive acute chest pain and non-obstructed coronary arteries. Heart 2020; 106:992-1000. [PMID: 32447308 PMCID: PMC7306881 DOI: 10.1136/heartjnl-2019-316295] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries. METHODS In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out. RESULTS CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality. CONCLUSIONS CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.
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Affiliation(s)
- Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Liliána Szabó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsófia Dohy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Attila Tóth
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - György Bárczi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - V Anna Gyarmathy
- EpiConsult LLC, Dover, Delaware, USA
- Johns Hopkins, Baltimore, Maryland, USA
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Abanador-Kamper N, Kamper L, Castello-Boerrigter L, Haage P, Seyfarth M. MRI findings in patients with acute coronary syndrome and unobstructed coronary arteries. ACTA ACUST UNITED AC 2019; 25:28-34. [PMID: 30582569 DOI: 10.5152/dir.2018.18004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The underlying diagnosis in patients with acute coronary syndrome (ACS) and unobstructed coronary arteries remains a diagnostic challenge. We analyzed the value of magnetic resonance imaging (MRI) in this clinical setting. METHODS A total of 213 patients with ACS and unobstructed coronary arteries underwent MRI within a median of 2 days after initial presentation. Clinical, laboratory, and MRI data were analyzed. A consensus diagnosis was established for each case by an independent panel after reviewing the individual clinical, laboratory, and MRI data. Standardized interviews to determine patient outcomes were carried out after a median follow-up of 24 months. Clinical events were defined as a composite of death, stroke, myocardial infarction or recurrence of Takotsubo syndrome (TTS), new onset of heart failure with a left ventricular ejection fraction (LVEF) <30%, and occurrence of a new left ventricular thrombus formation. RESULTS Final diagnoses included acute myocardial infarction (AMI) (40%), acute myocarditis (24%) and TTS (33%). In 3% of patients, nonspecific findings lead to an indeterminate diagnosis. Patients with TTS showed a significantly impaired LVEF during the index event (50% vs. 60% in AMI and 60% in myocarditis, P = 0.001). The extent of myocardial edema was most pronounced in patients with TTS (13.4%±11.4 vs. 4.6%±7.9 in AMI and 1.8%±2.7 in myocarditis, P < 0.001). TTS patients had the highest event rate (16.9%). CONCLUSION Our study emphasizes the diagnostic utility of timely MRI in patients with ACS and unobstructed coronary arteries. We found a high prevalence of TTS patients, who had poorer outcomes compared with patients with a final diagnosis of AMI or myocarditis.
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Affiliation(s)
- Nadine Abanador-Kamper
- Department of Cardiology, HELIOS University Hospital, Wuppertal, Germany; Center for Clinical Medicine, University Faculty of Health, Witten/Herdecke, Germany
| | - Lars Kamper
- Department of Diagnostic HELIOS University Hospital, Wuppertal, Germany; Center for Clinical Medicine University Faculty of Health, Witten/Herdecke, Germany
| | | | - Patrick Haage
- Center for Clinical Medicine,University Faculty of Health, Witten/Herdecke, Germany
| | - Melchior Seyfarth
- Center for Clinical Medicine,University Faculty of Health, Witten/Herdecke, Germany
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Panovský R, Borová J, Pleva M, Feitová V, Novotný P, Kincl V, Holeček T, Meluzín J, Sochor O, Štěpánová R. The unique value of cardiovascular magnetic resonance in patients with suspected acute coronary syndrome and culprit-free coronary angiograms. BMC Cardiovasc Disord 2017; 17:170. [PMID: 28659139 PMCID: PMC5490179 DOI: 10.1186/s12872-017-0610-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patients with chest pain, elevated troponin, and unobstructed coronary disease present a clinical dilemma. The purpose of this study was to investigate the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in a cohort of patients with suspected acute coronary syndrome (ACS) and unobstructed coronary arteries. Results Data files of patients meeting the inclusion criteria in two cardiology centres were searched and analysed. The inclusion criteria included: 1) thoracic pain suspected with ACS; 2) a significant increase in the high-sensitive Troponin T value; 3) ECG changes; 4) coronary arteries without any significant stenosis; 5) a CMR examination included in the diagnostic process; 6) an uncertain diagnosis before the CMR exam; and 7) the absence of known CMR and contrast media contraindications. Special attention was paid to the benefits of CMR in determining the final diagnosis. In total, 136 patients who underwent coronary angiography for chest pain were analysed. The most frequent underlying causes were myocarditis (38%) and perimyocarditis (18%), followed by angiographically unrecognised acute myocardial infarction (18%) and Takotsubo cardiomyopathy (15%). The final diagnosis remained unclear in 6% of the patients. The contribution of CMR in determining the final diagnosis determination was crucial in 57% of the patients. In another 35% of the patients, CMR confirmed the suspicion and, only 8% of the CMR examinations did not help at all and had no influence on diagnosis or treatment. Conclusion CMR provided a powerful incremental diagnostic value in the cohort of patients with suspected ACS and unobstructed coronary arteries. CMR is highly recommended to be incorporated as an inalienable part of the diagnostic algorithms in these patients.
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Affiliation(s)
- Roman Panovský
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic. .,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic.
| | - Júlia Borová
- The Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic
| | - Martin Pleva
- The Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic
| | - Věra Feitová
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The Department of Medical Imaging, St. Anne's Faculty Hospital and Masaryk University, Brno, Czech Republic
| | - Petr Novotný
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Vladimír Kincl
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Tomáš Holeček
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The Department of Medical Imaging, St. Anne's Faculty Hospital and Masaryk University, Brno, Czech Republic
| | - Jaroslav Meluzín
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Ondřej Sochor
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Radka Štěpánová
- International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
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11
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Barbaryan A, Bailuc SL, Patel K, Raqeem MW, Thakur A, Mirrakhimov AE. An Emotional Stress as a Trigger for Reverse Takotsubo Cardiomyopathy: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:137-42. [PMID: 26946334 PMCID: PMC4784546 DOI: 10.12659/ajcr.896549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Reverse Takotsubo cardiomyopathy is one of the rarest types of stress-induced cardiomyopathy, which despite sharing similar pathogenic mechanisms with its more common counterpart, has different clinical manifestations, demographics, and laboratory values. CASE REPORT We present the case of a 61-year-old woman who came to the hospital with a chief complaint of chest pain and dyspnea. She was found to have elevated troponin and severely depressed left ventricular function. Echocardiography showed normal contracting apex, with the rest of the left ventricle being hypokinetic. Cardiac catheterization revealed mild coronary artery disease and confirmed echocardiographic findings showing hyperkinetic apex and dilated base. She was discharged home on ACE inhibitor and B-blocker. A repeat echocardiogram 2 weeks after the initial presentation showed complete resolution of cardiac dysfunction. CONCLUSIONS Reverse Takotsubo cardiomyopathy is a rare disease mimicking acute coronary syndrome. It is essential to rule out organic coronary disease prior to attributing the presentation to Takotsubo cardiomyopathy. With supportive care, the long-term prognosis is good in the vast majority of patients.
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Affiliation(s)
- Aram Barbaryan
- Department of Internal Medicine, Hospital Sisters Health System - St. Mary's Hospital, Decatur, IL, USA
| | - Stefania L Bailuc
- Department of Internal Medicine, Hospital Sisters Health System - St. Mary's Hospital, Decatur, IL, USA
| | - Krishan Patel
- Department of Internal Medicine, Hospital Sisters Health System - St. Mary's Hospital, Decatur, IL, USA
| | - Muhammad Wajih Raqeem
- Department of Internal Medicine, Hospital Sisters Health System - St. Mary's Hospital, Decatur, IL, USA
| | - Atul Thakur
- Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
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12
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Zou Y, Lin L, Xiao H, Xiang D. A Rare Case of Toxic Myocarditis Caused by Bacterial Liver Abscess Mimicking Acute Myocardial Infarction. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:1-5. [PMID: 26726772 PMCID: PMC4708095 DOI: 10.12659/ajcr.895350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient: Male, 66 Final Diagnosis: Toxic myocarditis Symptoms: — Medication: — Clinical Procedure: Emergency Specialty: Cardiology
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Affiliation(s)
- Yuhai Zou
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland)
| | - Lin Lin
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland)
| | - Hua Xiao
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland)
| | - Dingcheng Xiang
- Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong, China (mainland)
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13
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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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14
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Saba L, Fellini F, De Filippo M. Diagnostic value of contrast-enhanced cardiac magnetic resonance in patients with acute coronary syndrome with normal coronary arteries. Jpn J Radiol 2015; 33:410-7. [DOI: 10.1007/s11604-015-0440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/14/2015] [Indexed: 01/01/2023]
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15
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Dunet V, Barras H, Boulanger X, Monney P, Qanadli SD, Meuli R, Schwitter J, Beigelman-Aubry C. Impact of extracardiac findings during cardiac MR on patient management and outcome. Med Sci Monit 2015; 21:1288-96. [PMID: 25943552 PMCID: PMC4548703 DOI: 10.12659/msm.893599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Cardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR. Material/Methods MR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up. Results Major IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001). Conclusions Screening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.
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Affiliation(s)
- Vincent Dunet
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Heloise Barras
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Xavier Boulanger
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre Monney
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiac MR Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiology, Division of Radiodiagnostics and interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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