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Review
. 2021 May 26;10(11):2331.
doi: 10.3390/jcm10112331.

Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Caelan Taggart  1 , Ryan Wereski  1 , Nicholas L Mills  1   2 , Andrew R Chapman  1
Affiliations
Review

Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Caelan Taggart et al. J Clin Med. .

Abstract

The application of high-sensitivity cardiac troponins in clinical practice has led to an increase in the recognition of elevated concentrations in patients without myocardial ischaemia. The Fourth Universal Definition of Myocardial Infarction encourages clinicians to classify such patients as having an acute or chronic myocardial injury based on the presence or absence of a rise or a fall in cardiac troponin concentrations. Both conditions may be caused by a variety of cardiac and non-cardiac conditions, and evidence suggests that clinical outcomes are worse than patients with myocardial infarction due to atherosclerotic plaque rupture, with as few as one-third of patients alive at 5 years. Major adverse cardiovascular events are comparable between populations, and up to three-fold higher than healthy individuals. Despite this, no evidence-based strategies exist to guide clinicians in the investigation of non-ischaemic myocardial injury. This review explores the aetiology of myocardial injury and proposes a simple framework to guide clinicians in early assessment to identify those who may benefit from further investigation and treatment for those with cardiovascular disease.

Keywords: myocardial infarction; myocardial injury; universal definition.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Sub-types of myocardial injury and infarction as per the Fourth Universal Definition of Myocardial Infarction.
Figure 2
Figure 2
Proposed mechanisms of cardiac cell damage and troponin release.
Figure 3
Figure 3
Systems-based approach to identifying causes of myocardial injury, listing common aetiologies in each system.
Figure 4
Figure 4
Mortality rates of non-ischaemic myocardial injury stratified into acute and chronic in studies from 2016 to 2020; titles are main study author and year as described in Table 1. Studies conducted before the 4th universal definition are displayed as total non-ischaemic myocardial injury, shape size is proportional to the number of study participants.
Figure 5
Figure 5
Taxonomy of myocardial injury and subclasses paired with basic investigation and management strategy.
See this image and copyright information in PMC

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