Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries.
JACC Cardiovasc Imaging
; 17(2): 149-161, 2024 Feb.
Article
em En
| MEDLINE
| ID: mdl-37480903
ABSTRACT
BACKGROUND:
Cardiac magnetic resonance (CMR) plays a pivotal diagnostic role in myocardial infarction with nonobstructive coronary arteries (MINOCA). To date, a prognostic stratification of these patients is still lacking.OBJECTIVES:
This study aims to assess the prognostic role of CMR in MINOCA.METHODS:
The authors assessed 437 MINOCA from January 2017 to October 2021. They excluded acute myocarditis, takotsubo syndromes, cardiomyopathies, and other nonischemic etiologies. Patients were classified into 3 subgroups according to the CMR phenotype 1) presence of late gadolinium enhancement (LGE) and abnormal mapping (M) values (LGE+/M+); 2) regional ischemic injury with abnormal mapping and no LGE (LGE-/M+); and 3) nonpathological CMRs (LGE-/M-). The primary outcome was the presence of major adverse cardiovascular events (MACE). The mean follow-up was 33.7 ± 12.0 months and CMR was performed on average at 4.8 ± 1.5 days from the acute presentation.RESULTS:
The final cohort included 198 MINOCA; 116 (58.6%) comprised the LGE+/M+ group. During follow-up, MACE occurred significantly more frequently in MINOCA LGE+/M+ than in the LGE+/M- and normal-CMR (LGE-/M-) subgroups (20.7% vs 6.7% and 2.7%; P = 0.006). The extension of myocardial damage at CMR was significantly greater in patients who developed MACE. In multivariable Cox regression, %LGE was an independent predictor of MACE (HR 1.123 [95% CI 1.064-1.185]; P < 0.001) together with T2 mapping values (HR 1.190 [95% CI 1.145-1.237]; P = 0.001).CONCLUSIONS:
In MINOCA with early CMR execution, the %LGE and abnormal T2 mapping values were identified as independent predictors of adverse cardiac events at â¼3.0 years of follow-up. These parameters can be considered as high-risk markers in MINOCA.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
MINOCA
/
Infarto do Miocárdio
Tipo de estudo:
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
JACC Cardiovasc Imaging
Ano de publicação:
2024
Tipo de documento:
Article