Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical management

Al-Hussaini, A. et al. (2020) Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical management. European Heart Journal, 41(23), pp. 2197-2205. (doi: 10.1093/eurheartj/ehz895) (PMID:31898721) (PMCID:PMC7299635)

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Aims: To report the extent and distribution of myocardial injury and its impact on left ventricular systolic function with cardiac magnetic resonance imaging (CMR) following spontaneous coronary artery dissection (SCAD) and to investigate predictors of myocardial injury. Methods and results: One hundred and fifty-eight angiographically confirmed SCAD-survivors (98% female) were phenotyped by CMR and compared in a case–control study with 59 (97% female) healthy controls (44.5 ± 8.4 vs. 45.0 ± 9.1 years). Spontaneous coronary artery dissection presentation was with non-ST-elevation myocardial infarction in 95 (60.3%), ST-elevation myocardial infarction (STEMI) in 52 (32.7%), and cardiac arrest in 11 (6.9%). Left ventricular function in SCAD-survivors was generally well preserved with small reductions in ejection fraction (57 ± 7.2% vs. 60 ± 4.9%, P < 0.01) and increases in left ventricular dimensions (end-diastolic volume: 85 ± 14 mL/m2 vs. 80 ± 11 mL/m2, P < 0.05; end-systolic volume: 37 ± 11 mL/m2 vs. 32 ± 7 mL/m2, P <0.01) compared to healthy controls. Infarcts were small with few large infarcts (median 4.06%; range 0–30.9%) and 39% having no detectable late gadolinium enhancement (LGE). Female SCAD patients presenting with STEMI had similar sized infarcts to female Type-1 STEMI patients age <75 years. Multivariate modelling demonstrated STEMI at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4 were associated with larger infarcts [>10% left ventricular (LV) mass]. Conclusion: The majority of patients presenting with SCAD have no or small infarctions and preserved ejection fraction. Patients presenting with STEMI, TIMI 0/1 flow, multivessel SCAD and those with features of connective tissue disorders are more likely to have larger infarcts.

Item Type:Articles
Additional Information:This study was supported by the British Heart Foundation (BHF) PG/13/ 96/30608, the NIHR rare disease translational collaboration, the Leicester NIHR Biomedical Research Centre and BeatSCAD. D.A. has received research funding (as below) from St Jude Medical (now Abbott vascular) to support a clinical fellow. G.P.M. is directly funded by the NIHR (CDF2014-07-45 and RP-2017-08-ST2-007). K.M. was funded by a BHF Clinical Training Fellowship (FS/15/54/31639). C.B. (RE/18/6134217) was supported by the British Heart Foundation. S.P. was supported by a BHF personal Chair (CH/16/2/32089). A.K.A. received research grants from the Egyptian ministry of high education and the British Heart Foundation (PG/18/42/33746). G.G. is funded by a British Heart Foundation Clinical Training Fellowship (32190).
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Mangion, Dr Kenneth
Authors: Al-Hussaini, A., Abdelaty, A. M.S.E.K., Gulsin, G. S., Arnold, J. R., Garcia-Guimaraes, M., Premawardhana, D., Budgeon, C., Wood, A., Natarajan, N., Mangion, K., Rakhit, R., Hoole, S. P., Johnson, T. W., Berry, C., Hudson, I., Gershlick, A. H., Ladwiniec, A., Kovac, J., Squire, I., Samani, N. J., Plein, S., McCann, G. P., and Adlam, D.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Heart Journal
Publisher:Oxford University Press
ISSN (Online):1522-9645
Published Online:03 January 2020
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in European Heart Journal 41(23): 2197-2205
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
172173Myocardial strain measurements in survivors of acute ST-elevation myocardial infarction: implementation and prognostic significance of novel magnetic resonance imaging methods.Colin BerryBritish Heart Foundation (BHF)FS/15/54/31639Institute of Cardiovascular & Medical Sciences
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science