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Multimodal cardiac imaging in patients with suspected ST-elevation myocardial infarction and no obstructive coronary arteries

Session Poster Session 1

Speaker Hedvig Bille Andersson

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Cross-Modality and Multi-Modality Imaging Topics
  • Session type : Poster Session

Authors : H Andersson (Copenhagen,DK), TE Christensen (Copenhagen,DK), K Ahtarovski (Copenhagen,DK), T Rasmussen (Copenhagen,DK), A Ghotbi (Copenhagen,DK), JH Thomsen (Copenhagen,DK), H Soeholm (Copenhagen,DK), L Nepper-Christensen (Copenhagen,DK), T Engstroem (Copenhagen,DK), N Vejlstrup (Copenhagen,DK), P Grande (Nykøbing Falster,DK), LE Bang (Copenhagen,DK), P Clemmensen (Hamburg,DE), P Hasbak (Copenhagen,DK), L Holmvang (Copenhagen,DK)

Authors:
H. Andersson1 , T.E. Christensen2 , K. Ahtarovski1 , T. Rasmussen2 , A. Ghotbi2 , J.H. Thomsen1 , H. Soeholm1 , L. Nepper-Christensen1 , T. Engstroem1 , N. Vejlstrup1 , P. Grande3 , L.E. Bang1 , P. Clemmensen4 , P. Hasbak2 , L. Holmvang1 , 1Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Department of Cardiology - Copenhagen - Denmark , 2Rigshospitalet - Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging - Copenhagen - Denmark , 3Nykøbing F Hospital - University of Southern Denmark, Odense, Denmark, Department of Medicine - Nykøbing Falster - Denmark , 4University Heart Center, Hamburg-Eppendorf, Department of General and Interventional Cardiology - Hamburg - Germany ,

Topic(s):
Cross-Modality and Multi-Modality Imaging Topics

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 223

Background: Patients with suspected ST-elevation myocardial infarction (STEMI) and normal coronary arteries comprise a heterogeneous group with various underlying causes of disease.

Purpose: To study pathophysiology and underlying diagnoses in patients with suspected STEMI and normal coronary arteries using multimodal cardiac imaging.

Methods: We consecutively included patients with suspected STEMI, normal coronary arteries on acute coronary angiography, and elevated troponin T levels at a tertiary heart center (2012–14). Patients were examined with echocardiography, cardiac magnetic resonance imaging, and 13NH3/82Rb and 18F-FDG positron emission tomography within one week from symptom onset.

Results: We included 42 patients (60% male, median age 58 (IQR 50–65) years. Median troponin T levels were 783 (IQR 566–1208) ng/l. Multimodal cardiac imaging findings are presented in Table 1. Multimodal cardiac imaging showed signs of cardiac involvement in all but one patient (98%). Underlying diagnoses were acute myocardial infarction (36%), Takotsubo cardiomyopathy (29%), perimyocarditis (10%), and cardiomyopathy (7%). The diagnosis was unclear in 19% of patients.

Conclusion: The majority of patients with suspected STEMI and normal coronary arteries had signs of cardiac involvement by multimodal cardiac imaging and were diagnosed with cardiac disease.

Echocardiography
  Left ventricular ejection fraction <40%, n (%)12 (29)
  Moderate to severe left ventricular hypertrophy, n (%)3 (7)
  Moderate to severe valvular disease, n (%)3 (7)
  Pericardial effusion, n (%)5 (12)
  Apical thrombus, n (%)1 (2)
Magnetic resonance imaging
  Left ventricular end diastolic volume, ml (IQR)157 (125–185)
  Left ventricular end systolic volume, ml (IQR)75 (63–88)
  Left ventricular stroke volume, ml (IQR)73 (57–93)
  Edema, n (%)38 (91)
  Late gadolinium enhancement, n (%)22 (52)
13NH3/82Rb and 18F-FDG positron emission computer tomography
  Myocardial perfusion defect, n (%)29 (69)
  Myocardial perfusion-metabolism mismatch, n (%)12/30 (40)
  Reduced myocardial viability, n (%)6/30 (20)

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