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Myocardial infarction without coronary artery obstruction: frequency and clinical features in different cardiac magnetic resonance patterns

Authors: Pisaryuk A.S.12, Tukhsanboev E.S., 12 Filatova D.A.1, Sidikov F.Kh.1, Kotova E.O.12, Mershina E.A.1, Meray I.A., 12 Pavlikova E.P.1, Sinitsyn V.E.1, Kobalava Zh.D.12

Company: 1 Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
2 Clinical Hospital named after V.V. Vinogradov, Moscow, Russian Federation
3 Lomonosov Moscow State University, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-3-328- 340

For citation: Pisaryuk A.S., Tukhsanboev E.S., Sidikov F.Kh., Kotova E.O., Mershina E.A., Filatova D.A., Meray I.A., Pavlikova E.P., Sinitsyn V.E., Kobalava Zh.D. Myocardial infarction without coronary artery obstruction: frequency and clinical features in different cardiac magnetic resonance patterns. Creative Cardiology. 2024; 18 (3): 328–340 (in Russ.). DOI: 10.24022/1997-3187-2024-18-3-328- 340

Received / Accepted:  26.05.2024 / 20.06.2024

Keywords: myocardial infarction with non-obstructive coronary artery obstruction acute myocardial infarction cardiovascular magnetic resonance late-gadolinium enhancement cardiomyopathies myocarditis coronary microvascular dysfunction



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Abstract

Objective. To study the frequency of different late gadolinium enhancement (LGE) patterns and clinical features of patients with myocardial infarction with myocardial infarction with non-obstructive coronary artery obstruction (MINOCA).

Material and methods. Thirty-three patients treated in intensive care unit with a working diagnosis of MINOCA (39.4% male, median age 59 [48–65]) were included in the study. All patients underwent cardiac magnetic resonance (CMR) with LGE in addition to routine examination. According to the results of CMR, the patients were divided into 3 groups: with ischemic pattern of contrast enhancement (“true” MINOCA), with non-ischemic pattern (myocarditis, cardiomyopathies, etc.) and without changes (“unclassified” MINOCA).

Results. Ischemic pattern of LGE was found in 6 (18.2%) patients, non-ischemic pattern in 9 (27.3%) and no changes 21 (54.5%) patients. In the group with non-ischemic pattern, myocarditis was diagnosed in 3 (33.3%) patients, takotsubo syndrome in two (22.2%), left ventricular hypertrophy in two (22.2%), dilated cardiomyopathy in one (11.1%) and arrhythmogenic biventricular cardiomyopathy in one (11.1%). Patients with ischemic pattern of LGE were characterized by predominantly male gender (83.3%, p = 0.008), significantly higher creatine creatine phosphokinase-MB (p = 0.05) and creatinine (p = 0.05), lower left ventricular ejection fraction (LV EF) (p = 0.048), higher blood pressure on admission (p = 0.016). Patients with non-ischemic pattern of LGE in one third of cases were of Asian race (p = 0.012) and were characterized by significantly higher level of leukocytes (p = 0.021) and neutrophils (p = 0.039), higher frequency of ST segment elevation on electrocardiogram (p = 0.017). Patients without detectable myocardial changes at CMR were predominantly women (83.3%, p = 0.008) and were characterized by the significantly lowest level of troponin I (p = 0.007). 

Conclusion. Non-ischemic pattern of contrast enhancement is more often detected in patients with working diagnosis of MINOCA at CMR. The presence of ischemic pattern is associated with traditional risk factors and was characterized by a more pronounced myocardial damage.

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About Authors

  • Aleksandra S. Pisaryuk, Cand. Med. Sci., Associate Professor in the Department of Internal Medicine with a course of cardiology and functional diagnostics named after V.S. Moiseev at RUDN University, Cardiologist in CCU in Clinical Hospital named after V.V. Vinogradov; ORCID
  • Ekub S. Tukhsanboev, Postgraduate in the Department of Internal Medicine with a course of cardiology and functional diagnostics named after V.S. Moiseev at RUDN University, Cardiologist in CCU in Clinical Hospital named after V.V. Vinogradov; ORCID
  • Darya A. Filatova, Postgraduate in the Radiology Department at the Faculty of Fundamental Medicine, Radiologist of Radiology Department at the University Hospital; ORCID
  • Farkhod H. Sidikov, Student; ORCID
  • Elizaveta O. Kotova, Dr. Med. Sci., Associate Professor in the Department of Internal Medicine with a course of cardiology and functional diagnostics named after V.S. Moiseev at RUDN University, Cardiologist in Clinical Hospital named after V.V. Vinogradov; ORCID
  • Elena A. Mershina, Cand. Med. Sci., Associate Professor in the Radiology department at the Faculty of Fundamental Medicine, Head of Radiology Department at the University Hospital; ORCID
  • Imad Meray, Cand. Med. Sci., Associate Professor in the Department of Internal Medicine with a Course of Cardiology and Functional Diagnostics named after V.S. Moiseev at RUDN University, Head of CCU in Clinical Hospital named after V.V. Vinogradov; ORCID
  • Elena P. Pavlikova, Dr. Med. Sci., Professor of the Department of Internal Medicine at the Faculty of Fundamental Medicine, Deputy Director of the University Hospital; ORCID
  • Valentin E. Sinitsyn, Dr. Med. Sci., Professor, Head and Chair of the Radiology department at the Faculty of Fundamental Medicine; ORCID
  • Zhanna D. Kobalava, Dr. Med. Sci., Professor, Head of Department of Internal Medicine with a course of Cardiology And Functional Diagnostics named after V.S. Moiseev at RUDN University, Head of the Internal Medicine Clinic in Clinical Hospital named after V.V. Vinogradov; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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