Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology Pub Date : 2024-10-09 DOI:10.1016/j.jelectrocard.2024.153813

Mitchell Pleasure BA , Vita N. Jaspan MD , Olivia Liu BA , Emilie Lin , Raymond Y. Kwong MD MPH , Julia Huang BS , Anais Hausvater MD , Tara Sedlak MD , Hayder Hashim MD , Caitlin Giesler MD , Kevin R. Bainey MD , Aun-Yeong Chong MD , Bobak Heydari MD MPH , Mobeen Ahmed MD , Nathaniel R. Smilowitz MD MS , Harmony R. Reynolds MD

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引用次数: 0

Abstract

Background

Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 6–15 % of MI patients. Cardiac magnetic resonance (CMR) imaging identifies MINOCA etiologies, but access may be limited.

Methods

We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI and < 50 % angiographic stenosis in all vessels were prospectively enrolled at 16 sites. CMR (median 6d from MI) was analyzed for late gadolinium enhancement (LGE), myocardial edema, and wall motion. We assessed ECGs for T-wave inversions (TWI), Q-waves (QW), ST-elevations (STE), ST-depressions (STD), and fragmented QRS complexes (fQRS). We calculated the DETERMINE score (# leads TWI + # fQRS +2*[# QW], excluding aVR, V1).

Results

Among 112 women with interpretable ECG, 81.3 % (91/112) had abnormal ECG; 50 % (56/112) had ≥1 TWI. CMR was abnormal in 74.1 % (83/112), with LGE in 49.1 % (55/112) and myocardial edema in 61.6 % (69/112). DETERMINE score ≥ 3 was associated with abnormal CMR (adjusted odds ratio [aOR] aOR 6.06 [1.89, 24.6], p = 0.002) and LGE (aOR 3.10 [1.26, 8.00], p = 0.013), but not edema (aOR 1.86 [0.80, 4.43], p = 0.152). TWI was also associated with abnormal CMR and LGE after adjustment (aOR 3.13 [1.08, 10.1], p = 0.036, aOR 3.23 [1.27, 8.63], p = 0.013, respectively), but not edema (aOR 1.26 [0.54, 2.96], p = 0.589). Specificity for abnormal CMR was 0.83 for DETERMINE score ≥ 3 and 0.75 for TWI. No other ECG findings were associated with CMR abnormality.

Conclusion

DETERMINE score ≥ 3 and the presence of any TWI were associated with abnormal CMR and with LGE in MINOCA. Our findings demonstrate that the index ECG can provide insight on CMR findings but without sensitivity or specificity required to forgo the CMR. We reaffirm the central role of CMR in elucidating MINOCA pathophysiology.

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冠状动脉无阻塞性心肌梗死女性患者心电图与心脏磁共振检查结果的相关性。

背景：冠状动脉非阻塞性心肌梗死（MINOCA）发生率占心肌梗死患者的 6-15%。心脏磁共振（CMR）成像可确定 MINOCA 的病因，但获取途径可能有限：我们评估了 MINOCA 中指数心电图（ECG）和 CMR 之间的关联。方法：我们评估了 MINOCA 中指数心电图与 CMR 之间的关联：在 112 名可解释心电图的女性中，81.3%（91/112）的人心电图异常；50%（56/112）的人 TWI ≥1。74.1%（83/112）的患者 CMR 异常，49.1%（55/112）的患者出现 LGE，61.6%（69/112）的患者出现心肌水肿。DETERMINE 评分≥3 与 CMR 异常相关（调整后比值比 [aOR] aOR 6.06 [1.89, 24.6]，p = 0.002）和 LGE 相关（aOR 3.10 [1.26, 8.00]，p = 0.013），但与水肿无关（aOR 1.86 [0.80, 4.43]，p = 0.152）。经调整后，TWI 也与异常 CMR 和 LGE 相关（分别为 aOR 3.13 [1.08, 10.1]，p = 0.036 和 aOR 3.23 [1.27, 8.63]，p = 0.013），但与水肿无关（aOR 1.26 [0.54, 2.96]，p = 0.589）。DETERMINE评分≥3对CMR异常的特异性为0.83，TWI为0.75。其他心电图结果均与 CMR 异常无关：结论：DETERMINE评分≥3分和任何TWI的存在与CMR异常和MINOCA中的LGE相关。我们的研究结果表明，指数心电图可提供有关 CMR 发现的洞察力，但没有放弃 CMR 所需的敏感性或特异性。我们重申了 CMR 在阐明 MINOCA 病理生理学方面的核心作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.