Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries

被引：45

作者：

Bergamaschi, Luca ^{[1
,2
]}

Foa, Alberto ^{[1
,2
]}

Paolisso, Pasquale ^{[3
,4
]}

Renzulli, Matteo ^{[5
]}

Angeli, Francesco ^{[1
,2
]}

Fabrizio, Michele ^{[1
,2
]}

Bartoli, Lorenzo ^{[1
,2
]}

Armillotta, Matteo ^{[1
,2
]}

Sansonetti, Angelo ^{[1
,2
]}

Amicone, Sara ^{[1
,2
]}

Stefanizzi, Andrea ^{[1
,2
]}

Rinaldi, Andrea ^{[1
,2
]}

Niro, Fabio ^{[6
,7
]}

Lovato, Luigi ^{[6
,7
]}

Gherbesi, Elisa ^{[2
,8
]}

Carugo, Stefano ^{[2
,8
]}

Pasquale, Ferdinando ^{[1
,2
]}

Casella, Gianni ^{[9
]}

Galie, Nazzareno ^{[1
,2
]}

Rucci, Paola ^{[10
]}

Bucciarelli-Ducci, Chiara ^{[11
,12
]}

Pizzi, Carmine ^{[1
,2
,13
]}

机构：

[1] IRCCS Azienda Osped Univ Bologna, Oncol Unit, Bologna, Italy

[2] Alma Mater Studiorum Univ Bologna, Dept Med & Surg Sci DIMEC, Bologna, Italy

[3] Cardiovasc Ctr Aalst, OLV Clin, Aalst, Belgium

[4] Univ Federico II, Dept Adv Biomed Sci, Naples, Italy

[5] IRCCS Azienda Osped Univ Bologna, Dept Radiol, Bologna, Italy

[6] IRCCS Azienda Osped Univ Bologna, Bologna, Italy

[7] Oncohematol & Emergency Radiol Unit, Pediat & Adult CardioThorac & Vasc, Milan, Italy

[8] Fdn IRCCS CaGranda Osped Maggiore Policlin, Internal Med Dept, Cardiovasc Dis Unit, Milan, Italy

[9] Maggiore Hosp, Unit Cardiol, Bologna, Italy

[10] Alma Mater Studiorum Univ Bologna, Dept Biomed & Neuromotor Sci, Div Hyg & Biostat, Bologna, Italy

[11] Guys & St Thomas NHS Fdn Trust, Royal Brompton & Harefield Hosp, London, England

[12] Kings Coll London, Fac Life Sci & Med, Sch Biomed Engn & Imaging Sci, London, England

[13] Univ Bologna, Dept Med & Surg Sci DIMEC Padiglione 23, Via Giuseppe Massarenti 9, I-40138 Bologna, Italy

来源：

JACC-CARDIOVASCULAR IMAGING | 2024年 / 17卷 / 02期

关键词：

cardiac magnetic resonance; LGE; mapping; MINOCA; prognosis; DIAGNOSIS; MINOCA; SIZE; CMR;

D O I：

10.1016/j.jcmg.2023.05.016

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 similar to 3.0 years of follow-up. These parameters can be considered as high-risk markers in MINOCA. (J Am Coll Cardiol Img 2024;17:149-161) (c) 2024 by the American College of Cardiology Foundation.

引用

页码：149 / 161

页数：13

共 34 条

[1] ESC working group position paper on myocardial infarction with non-obstructive coronary arteries [J].