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Unrecognized myocardial infarctions assessed by cardiovascular magnetic resonance are associated with the severity of the stenosis in the supplying coronary artery
Västmanland County Hospital Västerås, Department of Radiology, Västerås, Sweden; Uppsala University, Department of Radiology, Oncology & Radiation Science, Uppsala, Sweden.
Orebro University Hospital. Department of Cardiology.
Uppsala Clinical Research Centre, Uppsala, Sweden; Uppsala University, Departmentof Medical Sciences, Cardiology, Uppsala, Sweden.
Uppsala University, Department of Radiology, Oncology & Radiation Science, Uppsala, Sweden.
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2015 (English)In: Journal of Cardiovascular Magnetic Resonance, ISSN 1097-6647, E-ISSN 1532-429X, Vol. 17, 98Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background: A 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.

Methods: In 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.

Results: UMIs 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.

Conclusion: UMI 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.

Place, publisher, year, edition, pages
BioMed Central, 2015. Vol. 17, 98
Keyword [en]
Angiography, Coronary disease, Imaging, Infarction, Cardiovascular magnetic resonance
National Category
Family Medicine Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-49862DOI: 10.1186/s12968-015-0202-5ISI: 000365177100001PubMedID: 26585508Scopus ID: 2-s2.0-84947798080OAI: oai:DiVA.org:oru-49862DiVA: diva2:920533
Available from: 2016-04-18 Created: 2016-04-18 Last updated: 2017-03-15Bibliographically 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)
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Supervisors
Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2016-04-21Bibliographically approved

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