MINOCA: frequency and clinical features in different LGE-patterns

Abstract Background Data on the frequency and associations of identified LGE-patterns differ from source to source. Purpose To study the frequency and clinical associations of LGE-patterns (highlighted by CMR) in patients with a working diagnosis of MINOCA. Methods Thirty-four patients treated in CCU with a working diagnosis of MINOCA (38.2% male, median age 59.5 [48.0–65.0]) were included in the study. All patients underwent CMR using late gadolinium enhancement in addition to routine examination. According to the results of CMR, patients were divided into 3 groups: with ischemic pattern ("true" MINOCA), with non-ischemic pattern (myocarditis, cardiomyopathies, etc.) and without changes ("unclassified" MINOCA). The follow up was a call to the patient after 365 days, according to which information was collected on all events that occurred with the patient from the moment of hospitalization. Results Ischemic pattern was found in 6 (17.6%) patients, non-ischemic pattern in 10 (29.4%) and no changes 18 (52.9%) patients. In the group with non-ischemic pattern, myocarditis was diagnosed in 3 (30.0%) patients, takotsubo syndrome in two (20.0%), left ventricular hypertrophy in two (20.0%), dilated cardiomyopathy in two (20.0%) and arrhythmogenic biventricular cardiomyopathy in one (10.0%). Patients with ischemic pattern were characterized by predominantly male gender (83.3%, p=0.003), significantly higher frequency of smoker (33.3%, p=0.05), troponin I on admission (p=0.015), lower LV EF (p=0.047), higher BP on admission (p=0.007). Patients with non-ischemic pattern in one third of cases were of Asian race (p=0.014) and were characterized by significantly higher level of leukocytes (p=0.024), higher frequency of ST segment elevation on ECG (p=0.049) and the numbers of complications during hospitalization (p=0.014). Patients without detectable myocardial changes were predominantly women (83.3%, p=0.003) and were characterized by the significantly lowest level of troponin I (p=0.005). None of the patients in the study population died either in hospital or within a year after discharge. The rate of re-hospitalisations during the year did not differ significantly between the three groups and was: 33.3% for patients with ischaemic pattern (2 patients), 50.0% for patients with non-ischaemic pattern (5 patients), and 16.7% for patients with no detectable myocardial changes (3 patients) (p=0.174). Conclusion(s) In patients with a working diagnosis MINOCA, CMR more often reveals a non-ischaemic pattern. The detection of ischaemic pattern is associated with traditional risk factors and is characterised by more severe myocardial damage. The higher number of complications was registered in the group with non-ischaemic pattern. The most favourable course of the disease was in the group of patients in whom LGE-patterns were not detected, but in this group, within a year after discharge, patients had repeated requests for emergency care with the same symptoms.Fig. 1.Ishemic pattern  Fig. 2.ACM pattern