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. 2023 Mar 15;12(6):2266.
doi: 10.3390/jcm12062266.

Characteristics and Prognosis of a Contemporary Cohort with Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) Presenting Different Patterns of Late Gadolinium Enhancements in Cardiac Magnetic Resonance Imaging

Valentina Bucciarelli  1 , Francesco Bianco  1 , Alessia Di Francesco  2 , Piergiusto Vitulli  2 , Annaclara Biasi  2 , Martina Primavera  2 , Sara Belleggia  3 , Giuseppe Ciliberti  3 , Federico Guerra  3 , Jelena Seferovic  4 , Antonio Dello Russo  3 , Sabina Gallina  2
Affiliations

Characteristics and Prognosis of a Contemporary Cohort with Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) Presenting Different Patterns of Late Gadolinium Enhancements in Cardiac Magnetic Resonance Imaging

Valentina Bucciarelli et al. J Clin Med. .

Abstract

Background: To analyze the characteristics and prognosis of a contemporary cohort of patients with myocardial infarction with non-obstructed coronaries (MINOCA) were referred for cardiac magnetic resonance (CMR) imaging, focusing on late gadolinium enhancement (LGE) patterns.

Methods: We retrospectively examined and prospectively followed up with 135 patients (49 ± 21 years old, 48% female) undergoing CMR imaging due to a MINOCA diagnosis from 2014 to 2016. We grouped and analyzed the sample according to ischemic (focal or transmural) and non-ischemic LGE patterns. The primary outcome was cardiac-related death; the secondary outcome was a composite of cardiac-related rehospitalizations, the new occurrence of acute myocardial infarction (AMI), heart failure (HF), or arrhythmias.

Results: CMR exams were performed after a median of 28 days from the acute event. One-third of the ischemic MINOCA were first managed as myocarditis, while CMR helped to adopt a different therapy regimen in 22% of patients (30/135). After a median follow-up of 2.3 years, more cardiac-related deaths occurred in the ischemic than non-ischemic group (2 vs. 1, p = 0.36), but it was not statistically significant. The ischemic group also experienced more cardiac-related-rehospitalizations (42%, p < 0.001). In a multivariable Cox regression model, dyslipidemia, reduced left ventricular ejection fraction, ST-elevation at the hospitalization, and the LGE transmural pattern were the independent predictors of cardiac-related rehospitalizations.

Conclusions: In a contemporary cohort of MINOCA patients who underwent CMR, ischemic and non-ischemic patterns had distinct features and outcomes. Among the MINOCA patients, CMR can identify patients at higher risk who require more aggressive therapeutic approached and strict follow-up.

Keywords: cardiac magnetic resonance imaging; late gadolinium enhancement patterns; myocardial infarction with non-obstructed coronaries (MINOCA); myocarditis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Ischemic and non-ischemic CMR LGE patterns.
Figure 2
Figure 2
Kaplan–Meier survival estimates for cardiac-related rehospitalizations due to the new occurrence of acute myocardial infarction (AMI), heart failure (HF), or arrhythmias: (a) non-ischemic vs. ischemic CMR LGE patterns; (b) non-ischemic vs. focal-ischemic and transmural CMR LGE patterns.
See this image and copyright information in PMC

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