Unrecognized myocardial infarctions assessed by cardiovascular magnetic resonance are associated with the severity of the stenosis in the supplying coronary artery

Journal of Cardiovascular Magnetic Resonance

Research

Lars Johansson¹  Anna M. Nordenskjöld²  Tomas Bjerner³  Olov Duvernoy³  Håkan Ahlström³  Nermin Hadziosmanovic⁴  Bertil Lindahl⁵  Per Hammar⁶ 

[1] Astra Zeneca, Molndal, Sweden;Department of Cardiology, Örebro University Hospital, S-70182, Örebro, Sweden;Department of Radiology, Oncology and Radiation Science, Uppsala University, S-75185, Uppsala, Sweden;Uppsala Clinical Research Centre, S-75237, Uppsala, Sweden;Uppsala Clinical Research Centre, S-75237, Uppsala, Sweden;Department of Medical Sciences, Cardiology, Uppsala University, S-75105, Uppsala, Sweden;Västmanland County Hospital Västerås, Department of Radiology, S-72189, Västerås, Sweden;Department of Radiology, Oncology and Radiation Science, Uppsala University, S-75185, Uppsala, Sweden;

关键词: Angiography;    Coronary disease;    Imaging;    Infarction;    Cardiovascular magnetic resonance;   

DOI  :  10.1186/s12968-015-0202-5

 received in 2015-05-21, accepted in 2015-11-08,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundA previous study has shown an increased prevalence of late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) detected unrecognized myocardial infarction (UMI) with increasing extent and severity of coronary artery disease. However, the coronary artery disease was evaluated on a patient level assuming normal coronary anatomy. Therefore, the aims of the present study were to investigate the prevalence of UMI identified by LGE CMR imaging in patients with stable angina pectoris and no known previous myocardial infarction; and to investigate whether presence of UMI is associated with stenotic lesions in the coronary artery supplying the segment of the myocardium in which the UMI is located, using coronary angiography to determine the individual coronary anatomy in each patient.MethodsIn this prospective multicenter study, we included patients with stable angina pectoris and without prior myocardial infarction, scheduled for coronary angiography. A LGE CMR examination was performed prior to the coronary angiography. The study cohort consisted of 235 patients (80 women, 155 men) with a mean age of 64.8 years.ResultsUMIs were found in 25 % of patients. There was a strong association between stenotic lesions (≥70 % stenosis) in a coronary artery and the presence of an UMI in the myocardial segments supplied by the stenotic artery; it was significantly more likely to have an UMI downstream a stenosis ≥ 70 % as compared to < 70 % (OR 5.1, CI 3.1-8.3, p < 0.0001). 56 % of the UMIs were located in the inferior and infero-lateral myocardial segments, despite predominance for stenotic lesions in the left anterior descending artery.ConclusionUMI is common in patients with stable angina and the results indicate that the majority of the UMIs are of ischemic origin due to severe coronary atherosclerosis. In contrast to what is seen in recognized myocardial infarctions, UMIs are predominately located in the inferior and infero-lateral myocardial segments.Trial registrationThe PUMI study is registered at ClinicalTrials.gov (NCT01257282).

【 授权许可】

CC BY   
© Hammar et al. 2015