Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries
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. We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI...
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| Veröffentlicht in: | Journal of electrocardiology 2024-11, Vol.87, p.153813, Article 153813 |
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| creator | Pleasure, Mitchell Jaspan, Vita N. Liu, Olivia Lin, Emilie Kwong, Raymond Y. Huang, Julia Hausvater, Anais Sedlak, Tara Hashim, Hayder Giesler, Caitlin Bainey, Kevin R. Chong, Aun-Yeong Heydari, Bobak Ahmed, Mobeen Smilowitz, Nathaniel R. Reynolds, Harmony R. |
| description | 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.
We assessed associations between the index electrocardiogram (ECG) and CMR in MINOCA. Women with MI and |
| doi_str_mv | 10.1016/j.jelectrocard.2024.153813 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3119722776</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022073624002838</els_id><sourcerecordid>3119722776</sourcerecordid><originalsourceid>FETCH-LOGICAL-c253t-84cd1d12b541a87205cde66557b6563f47629bb5b5ee2a7108fdafaf6a52a6463</originalsourceid><addsrcrecordid>eNqNUctuHCEQRFGseOPkFyKUUy6z4THATm6R7TwkS74kZ8RAs2Y1Axtgbfkz_MdhM5vHMRcaUdVVdBdCbylZU0Ll-916BxPYmpM12a0ZYf2aCr6h_BlatQvrNj0nz9GKEMY6org8Ry9L2RFCBqbYC3TOh54r2Q8r9HT9VymkbTb7u2CxTTnDZCoUnDz-hRmLZ7ONUBucoaRoogXsQ3QhbgsOET-kGdoZ6h2eHxdBMzXAm2xrSCcoptilsdR8aI_3cLRqWvkRm1whByiv0Jk3U4HXp3qBvn-6_nb5pbu5_fz18uNNZ5ngtY1oHXWUjaKnZqMYEdaBlEKoUQrJfa8kG8ZRjAKAGUXJxjvjjZdGMCN7yS_Qu0V3n9OPA5Sq51AsTJOJkA5Fc0oHxZhSR-qHhWpzKiWD1_sc5vZpTYk-RqJ3-t9I9DESvUTSmt-cfA7jDO5P6-8MGuFqIUCb9j5A1sUGaNt1ITdJ7VL4H5-fTCKolQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3119722776</pqid></control><display><type>article</type><title>Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries</title><source>Elsevier ScienceDirect Journals Complete</source><creator>Pleasure, Mitchell ; Jaspan, Vita N. ; Liu, Olivia ; Lin, Emilie ; Kwong, Raymond Y. ; Huang, Julia ; Hausvater, Anais ; Sedlak, Tara ; Hashim, Hayder ; Giesler, Caitlin ; Bainey, Kevin R. ; Chong, Aun-Yeong ; Heydari, Bobak ; Ahmed, Mobeen ; Smilowitz, Nathaniel R. ; Reynolds, Harmony R.</creator><creatorcontrib>Pleasure, Mitchell ; Jaspan, Vita N. ; Liu, Olivia ; Lin, Emilie ; Kwong, Raymond Y. ; Huang, Julia ; Hausvater, Anais ; Sedlak, Tara ; Hashim, Hayder ; Giesler, Caitlin ; Bainey, Kevin R. ; Chong, Aun-Yeong ; Heydari, Bobak ; Ahmed, Mobeen ; Smilowitz, Nathaniel R. ; Reynolds, Harmony R.</creatorcontrib><description>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.
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).
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.
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.
•T wave inversions (TWI) were more prevalent in women with MINOCA with abnormal CMR•The DETERMINE score sums the number of leads with TWI, fractionated QRS and Q waves•The DETERMINE score predicted CMR abnormality better than other ECG components•The DETERMINE score was independently associated with CMR abnormality in our cohort•ECG findings correlated better with LGE than with edema on CMR in women with MINOCA</description><identifier>ISSN: 0022-0736</identifier><identifier>ISSN: 1532-8430</identifier><identifier>EISSN: 1532-8430</identifier><identifier>DOI: 10.1016/j.jelectrocard.2024.153813</identifier><identifier>PMID: 39437649</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiac MRI ; ECG ; MI with non-obstructive coronary arteries</subject><ispartof>Journal of electrocardiology, 2024-11, Vol.87, p.153813, Article 153813</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c253t-84cd1d12b541a87205cde66557b6563f47629bb5b5ee2a7108fdafaf6a52a6463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jelectrocard.2024.153813$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3554,27933,27934,46004</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39437649$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pleasure, Mitchell</creatorcontrib><creatorcontrib>Jaspan, Vita N.</creatorcontrib><creatorcontrib>Liu, Olivia</creatorcontrib><creatorcontrib>Lin, Emilie</creatorcontrib><creatorcontrib>Kwong, Raymond Y.</creatorcontrib><creatorcontrib>Huang, Julia</creatorcontrib><creatorcontrib>Hausvater, Anais</creatorcontrib><creatorcontrib>Sedlak, Tara</creatorcontrib><creatorcontrib>Hashim, Hayder</creatorcontrib><creatorcontrib>Giesler, Caitlin</creatorcontrib><creatorcontrib>Bainey, Kevin R.</creatorcontrib><creatorcontrib>Chong, Aun-Yeong</creatorcontrib><creatorcontrib>Heydari, Bobak</creatorcontrib><creatorcontrib>Ahmed, Mobeen</creatorcontrib><creatorcontrib>Smilowitz, Nathaniel R.</creatorcontrib><creatorcontrib>Reynolds, Harmony R.</creatorcontrib><title>Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries</title><title>Journal of electrocardiology</title><addtitle>J Electrocardiol</addtitle><description>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.
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).
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.
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.
•T wave inversions (TWI) were more prevalent in women with MINOCA with abnormal CMR•The DETERMINE score sums the number of leads with TWI, fractionated QRS and Q waves•The DETERMINE score predicted CMR abnormality better than other ECG components•The DETERMINE score was independently associated with CMR abnormality in our cohort•ECG findings correlated better with LGE than with edema on CMR in women with MINOCA</description><subject>Cardiac MRI</subject><subject>ECG</subject><subject>MI with non-obstructive coronary arteries</subject><issn>0022-0736</issn><issn>1532-8430</issn><issn>1532-8430</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNUctuHCEQRFGseOPkFyKUUy6z4THATm6R7TwkS74kZ8RAs2Y1Axtgbfkz_MdhM5vHMRcaUdVVdBdCbylZU0Ll-916BxPYmpM12a0ZYf2aCr6h_BlatQvrNj0nz9GKEMY6org8Ry9L2RFCBqbYC3TOh54r2Q8r9HT9VymkbTb7u2CxTTnDZCoUnDz-hRmLZ7ONUBucoaRoogXsQ3QhbgsOET-kGdoZ6h2eHxdBMzXAm2xrSCcoptilsdR8aI_3cLRqWvkRm1whByiv0Jk3U4HXp3qBvn-6_nb5pbu5_fz18uNNZ5ngtY1oHXWUjaKnZqMYEdaBlEKoUQrJfa8kG8ZRjAKAGUXJxjvjjZdGMCN7yS_Qu0V3n9OPA5Sq51AsTJOJkA5Fc0oHxZhSR-qHhWpzKiWD1_sc5vZpTYk-RqJ3-t9I9DESvUTSmt-cfA7jDO5P6-8MGuFqIUCb9j5A1sUGaNt1ITdJ7VL4H5-fTCKolQ</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Pleasure, Mitchell</creator><creator>Jaspan, Vita N.</creator><creator>Liu, Olivia</creator><creator>Lin, Emilie</creator><creator>Kwong, Raymond Y.</creator><creator>Huang, Julia</creator><creator>Hausvater, Anais</creator><creator>Sedlak, Tara</creator><creator>Hashim, Hayder</creator><creator>Giesler, Caitlin</creator><creator>Bainey, Kevin R.</creator><creator>Chong, Aun-Yeong</creator><creator>Heydari, Bobak</creator><creator>Ahmed, Mobeen</creator><creator>Smilowitz, Nathaniel R.</creator><creator>Reynolds, Harmony R.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20241101</creationdate><title>Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries</title><author>Pleasure, Mitchell ; Jaspan, Vita N. ; Liu, Olivia ; Lin, Emilie ; Kwong, Raymond Y. ; Huang, Julia ; Hausvater, Anais ; Sedlak, Tara ; Hashim, Hayder ; Giesler, Caitlin ; Bainey, Kevin R. ; Chong, Aun-Yeong ; Heydari, Bobak ; Ahmed, Mobeen ; Smilowitz, Nathaniel R. ; Reynolds, Harmony R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c253t-84cd1d12b541a87205cde66557b6563f47629bb5b5ee2a7108fdafaf6a52a6463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cardiac MRI</topic><topic>ECG</topic><topic>MI with non-obstructive coronary arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pleasure, Mitchell</creatorcontrib><creatorcontrib>Jaspan, Vita N.</creatorcontrib><creatorcontrib>Liu, Olivia</creatorcontrib><creatorcontrib>Lin, Emilie</creatorcontrib><creatorcontrib>Kwong, Raymond Y.</creatorcontrib><creatorcontrib>Huang, Julia</creatorcontrib><creatorcontrib>Hausvater, Anais</creatorcontrib><creatorcontrib>Sedlak, Tara</creatorcontrib><creatorcontrib>Hashim, Hayder</creatorcontrib><creatorcontrib>Giesler, Caitlin</creatorcontrib><creatorcontrib>Bainey, Kevin R.</creatorcontrib><creatorcontrib>Chong, Aun-Yeong</creatorcontrib><creatorcontrib>Heydari, Bobak</creatorcontrib><creatorcontrib>Ahmed, Mobeen</creatorcontrib><creatorcontrib>Smilowitz, Nathaniel R.</creatorcontrib><creatorcontrib>Reynolds, Harmony R.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of electrocardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pleasure, Mitchell</au><au>Jaspan, Vita N.</au><au>Liu, Olivia</au><au>Lin, Emilie</au><au>Kwong, Raymond Y.</au><au>Huang, Julia</au><au>Hausvater, Anais</au><au>Sedlak, Tara</au><au>Hashim, Hayder</au><au>Giesler, Caitlin</au><au>Bainey, Kevin R.</au><au>Chong, Aun-Yeong</au><au>Heydari, Bobak</au><au>Ahmed, Mobeen</au><au>Smilowitz, Nathaniel R.</au><au>Reynolds, Harmony R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries</atitle><jtitle>Journal of electrocardiology</jtitle><addtitle>J Electrocardiol</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>87</volume><spage>153813</spage><pages>153813-</pages><artnum>153813</artnum><issn>0022-0736</issn><issn>1532-8430</issn><eissn>1532-8430</eissn><abstract>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.
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).
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.
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.
•T wave inversions (TWI) were more prevalent in women with MINOCA with abnormal CMR•The DETERMINE score sums the number of leads with TWI, fractionated QRS and Q waves•The DETERMINE score predicted CMR abnormality better than other ECG components•The DETERMINE score was independently associated with CMR abnormality in our cohort•ECG findings correlated better with LGE than with edema on CMR in women with MINOCA</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39437649</pmid><doi>10.1016/j.jelectrocard.2024.153813</doi></addata></record> |
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| subjects | Cardiac MRI ECG MI with non-obstructive coronary arteries |
| title | Electrocardiographic correlates of cardiac magnetic resonance findings in women with myocardial infarction with non-obstructive coronary arteries |
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