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The tip of the iceberg - the role of CMR imaging in the diagnosis and management of patients with MINOCA based on an initial experience from the Polish single-centre MINOCA registry

Session Poster session 2

Speaker Piotr Gosciniak

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Imaging - Other
  • Session type : Poster Session

Authors : P Gosciniak (Szczecin,PL), TOMASZ Baron (Uppsala,SE), R Jozwa (Szczecin,PL), M Pyda (Poznan,PL)

Authors:
P Gosciniak1 , TOMASZ Baron2 , R Jozwa3 , M Pyda4 , 1Pomeranian Medical University, Non Invasive Cardiology Lab - Szczecin - Poland , 2Uppsala Clinical Research Center - Uppsala - Sweden , 3WSZ, Department of Cardiology - Szczecin - Poland , 4Poznan University of Medical Sciences, CMR Lab - Poznan - Poland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii374

A major role in the diagnostic evaluation of MINOCA is played by cardiac magnetic resonance (CMR) imaging which is currently the only available method that allows non-invasive evaluation of myocardial tissue characteristics
The aim of the study was to evaluate the incidence of MINOCA in the population of West Pomerania, Poland, and the utility of CMR in these patients based on 12-month follow-up in a large cardiology unit. The study employed a prospective observational registry design.
Over 12 months from January 2017 to December 2017, a total of 5006 patients were hospitalized in our unit. Over that period, 2756 coronary angiographies were performed, including 604 procedures in the setting of an acute coronary syndrome (327 NSTEMI and 277 STEMI).
Ultimately, we analysed 21 patients (3.5%), including 9 women and 12 men with an acute coronary syndrome who were found to have no significant obstructive coronary lesions, an abnormal troponin level, and no other clinically evident cause of the acute clinical presentation. Only those patients were initially diagnosed with MINOCA (n=21) in our study population. The mean patient age was 46 years. 
CMR was performed in the overall study group (n=21).
In the study group (n=21), the diagnosis of myocardial infarction (true MINOCA) was confirmed based on CMR imaging in 38% of patients (n=8). Myocarditis was diagnosed in 38% of patients (n=8). Stress-induced cardiomyopathy was diagnosed in 19% of patients (n=4). In one patient, CMR imaging yielded a normal result. (Table 1).

Total

n=21*

G1: true MINOCA

n=8

G2: myocarditis

n=8

G3: takotsubo

n=4

P

Women (%)

42.9

62.5

12.5

100

0.0898

Age, years (SD)

46 (14)

48 (14)

37 (7)

62 (17)

0.0132

G2 vs G3: 0.0106

Troponin T, ng/L

473 (203; 836)

470.5(244.5; 1013)

563(165.5; 928.5)

416.5(283.7; 726.5)

0.9529

CRP, mg/L

5.7 (2.5; 59)

2.6 (1.4; 5.1)

61 (40.6; 72.5)

8.8 (5.1; 51.4)

0.0127

G1 vsG2:0.0074

G1 vs G3: 0.0745

G2 vs G3: 0.3502

Hb, g/dL

13.9 (13.3; 14.5)

13.8 (12.3; 14.4)

14.6 (14; 16.0)

13.3 (12.7; 13.4)

0.0129

G1 vs G2:0.0403

G1 vs G3:0.3949

G2 vs G3: 0.0085

Time to CMR, days

5 (3; 7)

4,5 (3.5; 5.5)

5 (3; 6.5)

7 (5.5 ;7)

0.2249

LVEF, % (SD)

56 (13)

57 (9)

59 (6)

62 (13)

0.7756

LV mass, g (SD)

124 (34)

116 (29)

127 (19)

111 (22)

0.5375

Oedema (T2-weighted images), %

28,5

25

50

0

0.2198

LGE ischaemic pattern, %

33.3

87.5

0

0

<0.005

LGE non-ischaemic pattern, %

42.9

0

100

0

<0.0001

No LGE, %

23.8

12.5

0

100

0.0010

*1 patient with no changes in CMR

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