Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico
Background: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. Aim: To describe a population with MINOCA and its multi-image assessment using IVI or CMR...
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Sociedad Médica de Santiago
2020
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oai:scielo:S0034-988720200008010832020-12-26Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnósticoCataldo V.,PablaVerdugo,Fernando J.Dauvergne,ChristianGarcía,AlfonsoAntileo,PabloMonsalve,RodrigoPineda,FernandoMéndez,ManuelUriarte,PolentziAraya H.,MarioLlerena,PedroNauhm,YalilePereira,GonzaloRamos,CristóbalCoello V.,MarcoGarrido G.,ChristianDelgado A.,TomasGonzález,SoledadSandoval B.,Jorge Coronary Angiography Magnetic Resonance Imaging Myocardial Infarction Tomography, Optical Coherence Ultrasonography, Interventional Background: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. Aim: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. Material and Methods: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. Results: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. Conclusions: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.148 n.8 20202020-08-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000801083es10.4067/S0034-98872020000801083 |
| institution |
Scielo Chile |
| collection |
Scielo Chile |
| language |
Spanish / Castilian |
| topic |
Coronary Angiography Magnetic Resonance Imaging Myocardial Infarction Tomography, Optical Coherence Ultrasonography, Interventional |
| spellingShingle |
Coronary Angiography Magnetic Resonance Imaging Myocardial Infarction Tomography, Optical Coherence Ultrasonography, Interventional Cataldo V.,Pabla Verdugo,Fernando J. Dauvergne,Christian García,Alfonso Antileo,Pablo Monsalve,Rodrigo Pineda,Fernando Méndez,Manuel Uriarte,Polentzi Araya H.,Mario Llerena,Pedro Nauhm,Yalile Pereira,Gonzalo Ramos,Cristóbal Coello V.,Marco Garrido G.,Christian Delgado A.,Tomas González,Soledad Sandoval B.,Jorge Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico |
| description |
Background: Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is common. Cardiac magnetic resonance (CMR) and intravascular imaging (IVI) may be useful for establishing its etiology. Aim: To describe a population with MINOCA and its multi-image assessment using IVI or CMR. Material and Methods: Review of medical records, imaging and functional studies of patients with MINOCA treated in three different clinical centers between 2015 and 2019. Results: Twenty-eight patients with MINOCA and IVI were included. Seventy eight percent were women, 46% had hypertension, 32% smoked and 32% had dyslipidemia. At wall motion assessment, 46% presented apical ballooning pattern. In 36% of patients IVI identified lesions that explained the cause of MINOCA, namely plaque disruption (PD) in 18%, spontaneous coronary dissection in 11% and a thrombus without PD in 7%. Forty-six percent of patients had uncomplicated atherosclerotic plaques, and 36% had no pathological findings. CMR was performed in 50% of patients, identifying in all a diagnostic pattern. In nine cases it was compatible with stress cardiomyopathy, three cases had a myocarditis and two cases had transmural infarctions. PD and transmural late gadolinium enhancement were observed in 23% of patients with apical ballooning. Patients with a pattern of myocarditis did not have acute pathological findings at IVI. After a mean follow-up of 16.4±11.4 months, 3 patients with PD died. Conclusions: Among patients with MINOCA, there was a predominance of female gender with low cardiovascular risk factor load. The multi-image assessment allowed greater precision for etiological diagnosis of MINOCA. Apical ballooning was not pathognomonic for stress cardiomyopathy. PD was associated with mortality. |
| author |
Cataldo V.,Pabla Verdugo,Fernando J. Dauvergne,Christian García,Alfonso Antileo,Pablo Monsalve,Rodrigo Pineda,Fernando Méndez,Manuel Uriarte,Polentzi Araya H.,Mario Llerena,Pedro Nauhm,Yalile Pereira,Gonzalo Ramos,Cristóbal Coello V.,Marco Garrido G.,Christian Delgado A.,Tomas González,Soledad Sandoval B.,Jorge |
| author_facet |
Cataldo V.,Pabla Verdugo,Fernando J. Dauvergne,Christian García,Alfonso Antileo,Pablo Monsalve,Rodrigo Pineda,Fernando Méndez,Manuel Uriarte,Polentzi Araya H.,Mario Llerena,Pedro Nauhm,Yalile Pereira,Gonzalo Ramos,Cristóbal Coello V.,Marco Garrido G.,Christian Delgado A.,Tomas González,Soledad Sandoval B.,Jorge |
| author_sort |
Cataldo V.,Pabla |
| title |
Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico |
| title_short |
Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico |
| title_full |
Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico |
| title_fullStr |
Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico |
| title_full_unstemmed |
Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico |
| title_sort |
infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva: utilidad de las imágenes intravasculares y resonancia cardíaca en su diagnóstico |
| publisher |
Sociedad Médica de Santiago |
| publishDate |
2020 |
| url |
http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000801083 |
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