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How could cardiac magnetic resonance imaging help the differential diagnosis in MINOCA patients? - Single center data of a 10-year period

Session Myocardial infarction and non-obstructive coronary artery disease: MINOCA in men and women

Speaker Hajnalka Vago

Event : ESC Congress 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Myocardial Infarction with Non-obstructive Coronary Arteries
  • Session type : Advances in Science

Authors : H Vago (Budapest,HU), Z Dohy (Budapest,HU), C Czimbalmos (Budapest,HU), I Csecs (Budapest,HU), L Szabo (Budapest,HU), FI Suhai (Budapest,HU), A Toth (Budapest,HU), G Barczi (Budapest,HU), D Becker (Budapest,HU), B Merkely (Budapest,HU)

H. Vago1 , Z. Dohy1 , C. Czimbalmos1 , I. Csecs1 , L. Szabo1 , F.I. Suhai1 , A. Toth1 , G. Barczi1 , D. Becker1 , B. Merkely1 , 1Heart Center Semmelweis University - Budapest - Hungary ,

European Heart Journal ( 2018 ) 39 ( Supplement ), 676-677

Background/Introduction: The results of diagnostic methods routinely used in MINOCA patients are, in many cases, not conclusive. Cardiac magnetic resonance (CMR) has a crucial role in the detection of structural myocardial abnormalities.

Purpose: The aim of our study was to establish the prevalence of the underlying pathologies and how CMR changes the provisional diagnosis in patients with clinical signs of STEMI but normal coronary angiography. We also aimed to establish the outcome of patients with myocarditis and the characteristics of the scar/necrosis during their follow-up.

Methods: Between 2007–2017 244 consecutive patients (175 male; 38±16 y) with positive troponin levels, persistent chest pain and localized ST-elevation underwent CMR examination following normal coronary angiography in the first 1–7 days. Follow-up CMR scan was performed after 3–6 months in a subgroup of 75 patients with myocarditis, where adverse cardiac events (hospitalization due to heart failure or arrhythmia, cardiac death) were recorded. We prepared cine movie in long and short-axis planes, T2-weighted spectral inversion recovery, and delayed contrast enhancement images. Left ventricular end-diastolic and end-systolic volumes, ejection fraction (EF), mass (LVM) were evaluated and myocardial necrosis/scar was quantified.

Results: CMR proved myocarditis in 150 pts (128 male), acute myocardial infarction (MI) in 36 cases (20 male), Tako-Tsubo cardiomyopathy in 19 women, myocardial contusion in one case, in two cases CMR raised the suspicion of sarcoidosis and in 36 pts (25 male) there was no CMR abnormality (Figure 1). CMR findings modified the original diagnosis in 41% of the cases (n=101). EF was lower in Tako-Tsubo pts (42.1±9.2 vs MI:56.4±6.5; vs myocarditis:55.0±8.1; p<0.001), but there was no difference between myocarditis and MI. Compared to other groups, patients with myocarditis were younger and Tako-Tsubo patients were older (myocarditis: 31±11 y, Tako-Tsubo: 66±11 y, MI: 48±16 y). Comparing acute and follow-up CMR parameters EF increased (54.7±8.3 vs 60.2±5.0%), however the scar persisted in 75%. Compared to patients without scar on the follow-up CMR, the ones who had scar on the follow-up CMR had a lower EF and larger necrosis in the acute phase (53.2±8.2 vs 59.7±6.6%). No adverse cardiac event occurred during follow-up (mean:1775±790 days).

Conclusions: CMR findings modified the original diagnosis in 41% of the cases and proved myocarditis in 61%, myocardial infarction in 24% of the patients. However, in myocarditis mimicking STEMI the scar remains in 75% of the cases, the clinical and CMR follow-up proved good prognosis.

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