Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France; Bordeaux Cardio-Thoracic Research Centre, Bordeaux University, Hôpital Xavier Arnozan, Pessac, France.
Cardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France; Interventional Cardiology and Department of Cardiovascular Imaging, Clinique Saint Gatien, Tours, France.
JACC Cardiovasc Imaging. 2020 Dec;13(12):2619-2631. doi: 10.1016/j.jcmg.2020.05.045. Epub 2020 Aug 19.
Among all patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA), epicardial causes may be suspected when there is a correlation between electrocardiogram (ECG) changes and regional wall motion abnormalities (WMAs). We evaluated the diagnostic yield of intravascular optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) in this specific setting.
OCT is able to identify different morphologic features of coronary plaques that are well known causes of MINOCA. Furthermore, CMR has become the gold standard for detection of myocardial infarction in the setting of MINOCA.
In a prospective 2-center study, consecutive patients with MINOCA including ECG features of ischemia associated with corresponding WMAs underwent OCT and CMR.
Forty patients (mean age: 50 ± 11 years, 62.5% male, 32.5% with ST-segment elevation) were enrolled. Coronary arteries were normal on coronary angiography in 10 patients (25%); 18 patients (45%) presented minimal lumen irregularities, whereas the remaining 12 patients (30%) showed mild to moderate (≥30% but <50%) coronary lesions. Plaque rupture, eruptive calcific nodule, plaque erosion, lone thrombus, and spontaneous coronary artery dissection were found in 14 (35%), 1 (2.5%), 12 (30%), 3 (7.5%), and 2 (5%) patients, respectively. Acute myocardial infarction was evident at CMR in 31 of 40 patients (77.5%). Twenty-three patients (57.5%) had a substrate and/or diagnosis supported by both techniques with an evident relationship between the findings obtained by the 2 techniques. By coupling OCT with CMR, a substrate and/or diagnosis was found in 100% of cases.
OCT coupled with CMR can provide a clear substrate and/or diagnosis in the vast majority of patients presenting with MINOCA including ECG features of ischemia associated with corresponding WMAs.
在所有表现为非阻塞性冠状动脉心肌梗死（MINOCA）的患者中，当心电图（ECG）变化与区域性壁运动异常（WMAs）之间存在相关性时，可能怀疑为心外膜原因。我们评估了血管内光学相干断层扫描（OCT）和心脏磁共振（CMR）在这种特定情况下的诊断效果。
OCT 能够识别冠状动脉斑块的不同形态特征，这些特征是 MINOCA 的已知原因。此外，CMR 已成为 MINOCA 中心肌梗死检测的金标准。
在一项前瞻性的 2 中心研究中，连续纳入 MINOCA 患者，包括与相应 WMAs 相关的缺血性心电图特征，行 OCT 和 CMR 检查。
共纳入 40 例患者（平均年龄：50 ± 11 岁，62.5%为男性，32.5%为 ST 段抬高）。10 例患者（25%）冠状动脉造影正常；18 例患者（45%）表现为最小管腔不规则，其余 12 例患者（30%）显示轻度至中度（≥30%但<50%）冠状动脉病变。14 例（35%）患者发现斑块破裂、爆发性钙化结节、斑块侵蚀、孤立性血栓和自发性冠状动脉夹层；1 例（2.5%）患者发现孤立性血栓；12 例（30%）患者发现斑块破裂、爆发性钙化结节、斑块侵蚀；3 例（7.5%）患者发现斑块破裂；2 例（5%）患者发现自发性冠状动脉夹层。40 例患者中的 31 例（77.5%）CMR 显示急性心肌梗死。23 例（57.5%）患者两种技术均有发现，并存在明显的相关性，因此得到了确定的病变。将 OCT 与 CMR 结合，100%的患者都可以明确病因和/或诊断。
OCT 与 CMR 结合可在绝大多数表现为 MINOCA 包括与相应 WMAs 相关的缺血性心电图特征的患者中提供明确的病因和/或诊断。
