bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of cardiovascular magnetic resonance imaging and diagnostic yield in patients with acute myocardial infarction with nonobstructive coronary arteries
Authors: Junca Puig G , Teis Soley A , Kasa Yaglici G , Ferrer Sistach E , Lopez Ayerbe J , Vallejo Camazon N , Gual Capllonch F , Bayes Genis A , Delgado Garcia V 
Published: October 2022

Abstract

Background
Accurate diagnosis of the underlying cause of myocardial infarction (MI) without obstructive coronary artery disease (MINOCA) is crucial. Cardiovascular magnetic resonance (CMR) plays an important role in the work up of patients with MINOCA. However, the timing of performance of CMR may impact on the diagnosis yield.

Purpose
To establish the diagnostic yield of CMR in a large cohort of patients admitted with MINOCA based on the timing of referral to CMR.

Methods
All patients referred to CMR from January 2009 to February 2022 with MINOCA were included. Studies were performed on a 1.5 T or 3T scanners. SSFP cines, T2-weighted black-blood fat-sat images and DE-segmented GE IR images 10–15 minutes after iv gadolinium-DTPA administration (0.15mmol/kg) were performed in 3 long-axis and 11–15 parallel short-axis views. All images were reviewed and analyzed off-line with specialized post-processing software.

Results
A total of 203 patients (median age 49 years, 60% men) with MINOCA diagnosis were included. Main ECG alterations were ST-segment elevation (STE) (57%) and T wave inversion (19%). Mean peak high sensitivity (HS)-TnI levels were 3706pg/mL. Median time to CMR was 7 days (5–9 days). Mean LVEF was 58% (range 18–83%) and mean LVEDVi 77 mL/m2 (range 35–210 mL/m2). Regional wall abnormalities were present in 123 patients (62%). High signal in T2w images was detected in 153 cases (75%) and late gadolinium enhancement (LGE) in 143cases (71%). Final CMR diagnosis resulted in myocarditis in 46%, MI in 20%, Takotsubo in 18%, and other cardiomyopathies in 6.4%. CMR was normal in 15 patients and not conclusive in 1. When CMR was performed within 7 days of admission (median: 5 days (4–6 days); n: 116 patients), the distribution of diagnoses was myocarditis in 53%, MI in 20%, Takotsubo in 16%, other cardiomyopathies in 6% and normal CMR in 4%. Whereas, if CMR was performed after 7 days (median: 10 days (8–12 days); n: 87 patients), the diagnoses were as flows: myocarditis in 36%, MI in 22%, Takotsubo 20%, cardiomyopathies in 7%, not conclusive in 1% and normal CMR in 13% (Table 1).

Conclusions
CMR led to the underlying diagnosis of MINOCA in 92% of patients. Myocarditis was the most frequent diagnosis. The final diagnosis of myocarditis was more frequent when CMR was performed within 7 days with a lesser percentage of normal CMR.

Funding Acknowledgement
Type of funding sources: None.
Predictors of late gadolinium enhancement development and extension in myocardial infarction with non-obstructive coronary arteries
Authors: Amicone S , Bergamaschi L , Armillotta M , Sansonetti A , Stefanizzi A , Impellizzeri A , Suma N , Tattilo F P , Angeli F , Paolisso P , Rinaldi A , Foa' A , Casella G , Galie' N , Pizzi C 
Published: October 2022

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical entity and in its complex diagnostic approach cardiovascular magnetic resonance (CMR) plays a pivotal role.

Purpose
To characterize the differences of MINOCA patients with and without late gadolinium enhancement (LGE) at CMR and to identify the predictors for ischemic LGE development and extension.

Methods
We assessed 461 MINOCA cases from January 2016 to June 2021. MINOCA were defined according to the current European guidelines criteria. We excluded acute myocarditis, Tako-tsubo syndromes, cardiomyopathies, or non-pathological CMR. According to CMR imaging findings, our cohort was divided into two CMR phenotypes based on regional myocardial necrosis detected throughout LGE (“LGE-positive MINOCA”) or regional ischemic injury without LGE (“LGE-negative MINOCA”). Extended LGE was considered as the presence of &gt;2 segments with transmural LGE. Multivariate logistic regression analysis was used to determine the predictors of LGE and extended LGE.

Results
The final cohort included 175 MINOCA: 121 (69.1%) constituted the LGE-positive group. The mean time delay between acute clinical presentation and CMR was 6±2.9 days. At admission MINOCA LGE-patients more frequently presented angina and ST segment elevation (24% vs 7.4%, p=0.01), compared to LGE negative ones. Furthermore, the LGE positive group had a significantly greater infarct size, measured by peak hs-Troponin I values and left ventricular function (LVEF). The only predictor of LGE was the peak troponin value (OR 1.64, 95% CI 1.18–2.28, p=0.003), while predictors of extended LGE were ST-segment elevation at admission (OR 7.44, 95% CI 1.57–35.22, p=0.01), peak troponin values (OR 1.07, 95% CI 1.02–1.13, p=0.01) and the presence of non-obstructive coronary artery disease at coronary angiography (OR 5.49, 95% CI 1.20–25.09, p=0.028).

Conclusion
The presence and extension of LGE at early CMR evaluation is an important feature in the setting of MINOCA. In addition, simple baseline characteristics (such as ST elevation, peak troponin value and LVEF) may aid the identification of a greater ischemic necrosis burden at CMR and therefore these high-risk MINOCA subjects could be benefit from a stricter management effort.

Funding Acknowledgement
Type of funding sources: None.
Myocardial bridging is significantly associated with myocardial infarction with non-obstructive coronary arteries
Authors: Matta A , Nader V , Canitrot R , Delmas C , Bouisset F , Lhermusier T , Blanco S , Parada F C , Elbaz M , Carrie D , Galinier M , Roncalli J 
Published: October 2022

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a common disorder characterized by the presence of clinical criteria for acute myocardial infarction in the absence of obstructive coronary artery disease on angiography. We aim to investigate the relationship between myocardial bridging (MB) and MINOCA.

Methods
An observational retrospective study was conducted on 15,036 patients who had been referred for coronary angiography and who fulfilled the Fourth Universal Definition of Myocardial Infarction. The study population was divided into STEMI and non-STEMI patients, from which we defined two main groups: the MINOCA group and the coronary artery disease (CAD) group. Statistical analyses were carried out by using SPSS, version 20.

Results
The prevalence of angiographic MB among the groups was significantly greater in the MINOCA group (2.9% vs. 0.8%). MINOCA accounted for 14.5% of spontaneous myocardial infarction, and the clinical presentation was frequently NSTEMI rather than STEMI (84.3% vs. 15.7%). After adjusting for confounders, multivariate analyses showed a positive association between MB and MINOCA [OR=3.28, 95% CI (2.34; 4.61) p&lt;0.001]. Cardiovascular risk factors were less common in the MINOCA population, which was younger and more often female.

Conclusion
MB is a risk factor for MINOCA. Because MB prevalence differed significantly between the controls (CAD group) and cases (MINOCA group), which were positively associated to MB, it seems likely that MB would be a potential cause of MINOCA. Investigations for MB in MINOCA cases and especially in NSTEMI patients seem necessary.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Rangueil Hospital
Prognostic role of early cardiac magnetic resonance in myocardial infarction with non-obstructive coronary arteries
Authors: Armillotta M , Bergamaschi L , Amicone S , Sansonetti A , Stefanizzi A , Impellizzeri A , Tattilo F P , Angeli F , Fabrizio M , Paolisso P , Rinaldi A , Foa' A , Casella G , Galie' N , Pizzi C 
Published: October 2022

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a significant proportion of acute myocardial infarction (AMI) population. MINOCA is a working diagnosis and an accurate investigation of the underlying causes should always be performed. In this setting, cardiac magnetic resonance (CMR) imaging plays a pivotal diagnostic role. However, a prognostic stratification based on the CMR findings in ischemic MINOCA is still unavailable.

Purpose
To evaluate the potential prognostic impact of specific CMR findings - especially ischemic late gadolinium enhancement (LGE) patterns - in order to look for measurable parameters that may guide the management of this still troubled clinical entity.

Methods
We assessed 461 MINOCA from January 2016 to June 2021. We excluded acute myocarditis, Tako-tsubo syndromes, cardiomyopathies, or non-pathological CMR. According to CMR findings, MINOCA were classified in two phenotypes: LGE-positive (an ischemic subendocardial or transmural LGE pattern) or LGE-negative (cases without LGE but exhibiting regional myocardial injury defined by myocardial edema in a coronary territory with a typically ischemic “wave-front” and/or regional wall motion abnormality consistent with coronary distribution).
All-cause mortality, re-infarction, stroke, heart failure (HF) and the composite endpoint (MACE) were evaluated. Extended LGE was considered as the presence of &gt;2 segments with transmural LGE. The mean follow-up was 36.1±15.2 months and CMR was performed at a mean of 6±2.9 days from the acute presentation.

Results
The final cohort included 175 MINOCA with a likely-ischemic etiology: 121 (69.1%) constituted the LGE-positive group. The mean age of the study population was 62.3±12.9 years and more than 61% were females. During follow-up, HF (15.7% vs 1.9%, p=0.008) and MACE (20.7% vs 7.4%, p=0.029) occurred more frequently in MINOCA “LGE-positive” compared to the “LGE-negative” ones. Extended LGE was significantly more prevalent in patients with versus without subsequent HF. On multivariable Cox regression, extended LGE was an independent predictor of HF occurrence (HR 18.49, 95% CI 4.65–73.61, p&lt;0.001) and MACE (HR 14.64, 95% CI 3.91–54.86, p&lt;0.001).

Conclusions
Our data suggest that in MINOCA patients the detection of LGE is correlated with the incidence of major cardiovascular events and heart failure during long-term follow-up. In fact, LGE extension was identified as the strongest predictor of cardiac adverse events. The early execution of CMR is useful in the prognostic stratification of MINOCA and this could guide the subsequent clinical and therapeutic management.

Funding Acknowledgement
Type of funding sources: None.
Myocardial infarction with non-obstructive coronary arteries (MINOCA): predictors of long-term outcome
Authors: Abad Romero R , Fraile Sanz A , Izquierdo Coronel B , Olsen Rodriguez R , Perela Alvarez C , Galan Gil D , Espinosa Pascual M J , Nieto Ibanez D , Alvarez Bello M , Martin Munoz M , Mata Caballero R , Awamleh Garcia P , Moreno Vinues C , Lopez Pais J , Alonso Martin J J 
Published: October 2022

Abstract

Introduction
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical entity. There is still limited knowledge about long-term prognosis of MINOCA patients. The aim of this study was to assess the incidence, time-to-event and predictors of mayor adverse cardiovascular events (MACE) in the long-term follow-up.

Methods
We carried out an analytical and observational study including all consecutive patients admitted to our hospital with acute myocardial infarction. Patients were classified as obstructive coronary artery disease (MICAD) or MINOCA using the definition of 2020 ESC acute coronary syndrome guidelines. Cardiovascular death, myocardial infarction, stroke and cardiovascular readmission were considered MACE. To determine MINOCA independent predictors, a multivariate analysis with cox regression was carried out in those variables with clinical or statistical relevance.

Results
During the studied period, 805 patients were included and 81 (10.1%) of them were diagnosed with MINOCA. Baselines characteristics of MINOCA patients: 53% were men, the mean age was 65±15 years, 67% suffered hypertension, 48% dyslipidemia, 21% mellitus diabetes and 43% were smokers. Follow-up (middle [interquartile range] 38 [19–57] months) was completed in 80 (99%) MINOCA patients and 18 (23%) of them had MACE (8 deaths, 6 myocardial infarctions, 2 strokes and 14 readmissions). The mean time to MACE was 53±2.9 months (Figure 1). Comparing MICAD vs. MINOCA, the 6 years rates of MACE (29% vs. 23%), mortality (12.7% vs. 10.0%), myocardial infarctions (6.5% vs. 7.5%), strokes (2.8% vs. 2.5%) and readmissions (17.5% vs. 24.2%) were similar with no statistically significant differences between MICAD and MINOCA patients.
In the multivariate analysis (Table 1) chronic heart failure (HR=18.89; 95% CI 4.94–72.20) and peripheral vascular disease (HR=4.86; 95% CI 1.29–18.36) were independent predictors of MACE in MINOCA patients. The predictive model has a R2 of Nagelkerke of 0.07.

Conclusion
This study shows that chronic heart failure and peripheral vascular disease are associated with adverse outcomes in MINOCA patients and appears to be independent predictors of MACE in the long-term follow-up. Those predictors seem to be similar to factors previously shown to predict MACE in MICAD patients.

Funding Acknowledgement
Type of funding sources: None.
Impact of left bundle branch block in patients with takotsubo cardiomyopathy
Authors: Lopez J , Karpel D , Mark J , Wahood W , Jazaerly M , Ramos F , Chait R 
Published: October 2022

Abstract

Background
Takotsubo cardiomyopathy (TCM) is a syndrome characterized by reversible left-ventricular regional systolic dysfunction in the absence of obstructive coronary artery disease (CAD). The presence of left bundle branch block (LBBB) has been described as an independent predictor of mortality in patients with CAD. One study using the National Inpatient Sample (NIS) for 2016 found that the presence of LBBB was associated with worse outcomes in patients with TCM.

Purpose
To better clarify the association between LBBB and various in-hospital outcomes in patients with TCM.

Methods
The NIS database was queried from 2016–2019 to identify all admissions with a primary diagnosis of TCM that had a cardiac catheterization to improve the specificity of the diagnosis. International classification of diseases, tenth revision clinical modification (ICD-10-CM) codes were used to divide patients based on the presence or absence of LBBB. A 1:3 propensity score matching based on age, race, gender, and risk factor stratification was used to reduce selection bias. Multivariate linear and logistic regression analysis was performed to compare various outcomes among both groups.

Results
A total of 27,125 patients admitted with a primary diagnosis of TCM that also underwent diagnostic coronary angiography were identified. In the study sample, 955 (3.5%) were determined to have a LBBB. After calculating propensity scores, 955 patients with LBBB were paired to 2,865 patients without LBBB. LBBB was associated with higher rates of ventricular arrhythmias (AOR=3.098, 95% CI 1.483–6.471, p=0.003); however, it was not statistically associated with cardiogenic shock, sudden cardiac arrest (SCA), acute kidney injury, acute heart failure, and hospital length of stay. In addition, there was no statistical difference in intra-hospital mortality.

Conclusions
LBBB is associated with left ventricular dyssynchrony. It has been proposed that intraventricular dyssynchrony might be a predisposing factor for ventricular arrhythmias (VA) and SCA. Several trials have demonstrated that cardiac resynchronization therapy alone (i.e., without defibrillation) reduces the rate of VA and SCA. The mechanism for this improvement is unclear but may be related to hemodynamic improvement from ventricular synchrony in heart failure (HF). In fact, LBBB has been reported as an independent risk factor for all-cause mortality and SCA at one year in patients with HF. Our analysis did not find any significant association between LBBB and SCA but did find an association with VA. Moreover, there were not enough events of intra-hospital mortality to assess a possible association between LBBB and mortality. Therefore, a prospective study with a longer follow-up would be needed to clarify the role of LBBB in mortality and establish causality between LBBB and VA in patients with TCM.

Funding Acknowledgement
Type of funding sources: None.
Takostubo syndrome during the COVID-19 pandemic: a single center experience
Authors: Rallidis L , Iordanidis D , Kosmas N , Kiouri E , Papathanasiou K , Vlachos S , Filippatos G 
Published: October 2022

Abstract

Background
Takotsubo syndrome (TTS) is a major psychosomatic cardiovascular disease. It has been suggested that in the current pandemic of coronavirus disease 2019 (COVID-19), the psychological, mental and physical consequences of the restrictive measures taken to combat the pandemic, is likely to make individuals more vulnerable to TTS.

Purpose
In our study, we investigated whether TTS incidence has increased during the COVID-19 era in a major tertiary hospital in Athens.

Methods
The study population included 316 consecutive patients admitted to the Coronary Care Unit (CCU) of our hospital throughout the 16 months (March 2020-June 2021) pandemic COVID-19 with the initial diagnosis of acute coronary syndrome (ACS). For comparison 342 patients with ACS admitted to CCU during the 16 months period preceding the COVID-19 pandemic (November 2018-February 2020) were analyzed. All ACS patients underwent coronary angiography within 48 hours of admission. A prerequisite for admission to CCU of all ACS patients during the pandemic period was a negative reverse transcription-polymerase chain reaction test for COVID-19.

Results
The vast majority (95%) of TTS patients were women and the mean age was 71.1±15.4 years. There was a significant increase in the incidence of TTS during the 16 months COVID-19 period (6.3%, i.e., 20 TSS among 316 ACS patients) compared with the corresponding incidence of TTS 16 months prior the pandemic (2.6%, i.e., 9 TTS among 342 ACS patients) [Figure 1]. The incidence rate ratio comparing the TTS cases of COVID-19 pandemic period to the pre-pandemic period was 2.22 (95% CI: 0.97–5.54, p=0.021).

Conclusions
COVID-19 pandemic was associated with a significant increase in the incidence of TTSprobably due to the additional psychological burden imposed by the pandemic.

Funding Acknowledgement
Type of funding sources: None.
Cardiac troponin elevation and mortality in takotsubo syndrome: new insights from the International Takotsubo (InterTAK) registry
Authors: Stahli B E , Schindler M , Cammann V L , Szawan K A , Schweiger V , Niederseer D , Schonberger A , Schonberger M , Koleva I , Mercier J C , Petkova V , Wurdinger M , Ruschitzka F , Ghadri J R , Templin C 
Published: October 2022

Abstract

Background/Introduction
Cardiac biomarker elevations are frequently observed in Takotsubo syndrome (TTS). The clinical relevance of cardiac troponin (cTn) elevations in TTS patients remains uncertain and threshold values indicating clinically relevant myocardial injury are unknown.

Purpose
This study sought to investigate the role of cTn elevations in mortality prediction of patients with TTS.

Methods
A total of 2,938 patients enrolled in the prospective International Takotsubo (InterTAK) Registry from January 2011 to February 2020 and with available data on baseline and peak cTn levels were included in the analysis. The threshold at which myocardial injury drives mortality was identified using restricted cubic spline analysis.

Results
Out of 2,938 patients, 222 (7.6%) patients died during 1-year follow-up. A more than 28.8-fold increase of cTn above the upper reference limit was identified as threshold for clinically relevant myocardial injury. Mortality at 1 year was significantly higher in patients with clinically relevant myocardial injury than in those without (Log Rank p&lt;0.001, Figure 1). The presence of clinically relevant myocardial injury was significantly associated with an increased risk of mortality at 5 years (adjusted HR 1.58, 95% CI 1.18–2.12, p=0.002). Clinically relevant myocardial injury was related to 5-year mortality in patients with apical TTS (adjusted HR 1.57, 95% CI 1.21–2.03, p=0.001), with presence of physical stressors (adjusted HR 1.60, 95% CI 1.22–2.11, p=0.001), and with absence of emotional stressors (adjusted HR 1.49, 95% CI, 1.17–1.89, p=0.001).

Conclusions
This study for the first time determined a troponin threshold for the identification of TTS patients at excess risk of mortality. These findings advance risk stratification in TTS and assist in identifying patients in need for close monitoring and follow-up.

Funding Acknowledgement
Type of funding sources: Foundation.
Impact of limbs pneumatic compression during cardiopulmonary resuscitation (CPR) on cardiac arrest patients: a randomized controlled trial
Authors: Han B , Li B , Guifeng Z 
Published: October 2022

Abstract

Background
Limbs pneumatic compression during cardiopulmonary resuscitation (CPR) for cardiac arrest patient were rarely reported.

Purpose
To evaluate the effect of this therapy on the patients of cardiac arrest.

Methods
A randomized, controlled and trial, a total of 62 elderly (75.8±8.3 yrs) cardiac arrest patients were included and randomized to “CPR group” (n=31) and “CPR + Pneumatic Compression group” (n=31). Each individual in CPR group received standard CPR. In addition to the standard CPR, all patients in “Pneumatic Compression group” accepted intermittent pneumatic compression (IPC) by Air Compression Therapy System, which digital six-tiered rippling full-body pressure (0.45–0.6 kg/cm2) and 1 minute interval every 5 minutes.

Results
Compared with standard CPR group, significant improvements of cardiac output (CO) and survival of patient were found in Pneumatic Compression group (Figure 1). Patients with pneumatic compression had lower incidence (19.4% vs. 45.2%, p=0.03) of acute kidney injury (AKI) than that in standard CPR group. Besides, the lower occurrence of hypoxic ischemic encephalopathy (HIE) was observed in Pneumatic Compression group (Figure 2). There was no ischemic myonecrosis of limbs caused by compression.

Conclusions
Intermittent limbs pneumatic compression during cardiopulmonary resuscitation (CPR) maybe could improve the blood flow of the crucial organs (e.g. brain) and increase survival of cardiac arrest patients, which is superior to the strategy for CPR alone.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): SHOU FA2020-4-1045 Fundation