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Unrecognized myocardial infarction assessed by cardiac magnetic resonance imaging: prognostic implications
Örebro University, School of Health Sciences. Department of Cardiology.
Department of Radiology, Västmanland Hospital Västerås, Västerås, Sweden.
Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden.
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2, e0148803Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background: Clinically unrecognized myocardial infarctions (UMI) are not uncommon and may be associated with adverse outcome. The aims of this study were to determine the prognostic implication of UMI in patients with stable suspected coronary artery disease (CAD) and to investigate the associations of UMI with the presence of CAD.

Methods and Findings: In total 235 patients late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were performed. For each patient with UMI, the stenosis grade of the coronary branch supplying the infarcted area was determined. UMIs were present in 25% of the patients and 67% of the UMIs were located in an area supplied by a coronary artery with a stenosis grade >= 70%. In an age-and gender-adjusted model, UMI independently predicted the primary endpoint (composite of death, myocardial infarction, resuscitated cardiac arrest, hospitalization for unstable angina pectoris or heart failure within 2 years of follow-up) with an odds ratio of 2.9; 95% confidence interval 1.1-7.9. However, this association was abrogated after adjustment for age and presence of significant coronary disease. There was no difference in the primary endpoint rates between UMI patients with or without a significant stenosis in the corresponding coronary artery.

Conclusions: The presence of UMI was associated with a threefold increased risk of adverse events during follow up. However, the difference was no longer statistically significant after adjustments for age and severity of CAD. Thus, the results do not support that patients with suspicion of CAD should be routinely investigated by LGE-CMR for UMI. However, coronary angiography should be considered in patients with UMI detected by LGE-CMR.

Place, publisher, year, edition, pages
Public Library Science , 2016. Vol. 11, no 2, e0148803
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:oru:diva-49552DOI: 10.1371/journal.pone.0148803ISI: 000371218400049PubMedID: 26885831Scopus ID: 2-s2.0-84960516971OAI: oai:DiVA.org:oru-49552DiVA: diva2:915168
Funder
Swedish Research CouncilSwedish Heart Lung Foundation, 20140486
Note

Funding Agencies:

Regional Research Council, Uppsala-Örebro region RFR-84261

Center for Clinical Research in Vastmanland from Bayer Pharmaceuticals Sweden

Available from: 2016-03-29 Created: 2016-03-29 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Unrecognized myocardial infarction and cardiac biochemical markers in patients with stable coronary artery disease
Open this publication in new window or tab >>Unrecognized myocardial infarction and cardiac biochemical markers in patients with stable coronary artery disease
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overarching aim of the thesis was to explore the occurrence and clinical importance of two manifestations of myocardial injury; unrecognized myocardial injury (UMI) and altered levels of cardiac biochemical markers in patients with stable coronary artery disease (CAD).

Methods: A prospective multicenter cohort study investigated the prevalence, localization, size, and prognostic implication of UMI in 235 patients with stable CAD. Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) imaging and coronary angiography were used. The relationship between UMI and severe CAD and cardiac biochemical markers was explored. In a substudy the short- and longterm individual variation in cardiac troponins I and T (cTnI, cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were investigated.

Results: The prevalence of UMI was 25%. Subjects with severe CAD were significantly more likely to exhibit UMI than subjects without CAD. There was a strong association between stenosis ≥70% and presence of UMI in the myocardial segments downstream. The presence of UMI was associated with a significant threefold risk of adverse events during follow up. After adjustments UMI was associated with a nonsignificant numerically doubled risk. The levels of cTnI, NT-proBNP, and Galacin-3 were associated with the presence of UMI in univariate analyses. The association between levels of cTnI and presence of UMI remained significant after adjustment. The individual variation in cTnI, cTnT, and NT-proBNP in subjects with stable CAD appeared similar to the biological variation in healthy individuals.

Conclusions: UMI is common and is associated with significant CAD, levels of biochemical markers, and an increased risk for adverse events. A change of >50% is required for a reliable short-term change in cardiac troponins, and a rise of >76% or a fall of >43% is required to detect a long-term reliable change in NT-proBNP.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 125 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 142
Keyword
Unrecognized myocardial infarction, Coronary artery disease, Prevalence, Prognosis, Troponin, NT-proBNP, Galectin-3
National Category
Family Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-48240 (URN)978-91-7529-125-3 (ISBN)
Public defence
2016-05-13, Universitetssjukhuset, hörsal C3, Södra Grev Rosengatan, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2017-10-17Bibliographically approved

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