1. Liliána Szabó - Semmelweis University Heart and Vascular Center
2. Viktor Horváth - Semmelweis University Heart and Vascular Center
3. Zsófia Dohy - Semmelweis University Heart and Vascular Center
4. Csilla Czimbalmos - Semmelweis University Heart and Vascular Center
5. Attila Tóth - Semmelweis University Heart and Vascular Center
6. Ferenc Suhai - Semmelweis University Heart and Vascular Center
7. Béla Merkely - Semmelweis University Heart and Vascular Center
8. Hajnalka Vágó - Semmelweis University Heart and Vascular Center
Introduction: Diagnostic performance of CMR based deformation imaging (feature tracking - FT) has been demonstrated in various groups of patients. However, the capability of this method to distinguish between pts with MINOCA unclear.
Aims: We aimed to compare standard CMR parameters and investigate the differential diagnostic value of CMR-FT myocardial strain in pts with MINOCA.
Methods: From our consecutive register of pts with troponin positive acute coronary syndrome (n=234 pts) we enrolled 100 pts (47.7±14y) in this study. Twenty-five pts were selected randomly from each group of acute myocardial infarction (MI), acute myocarditis, Tako-Tsubo cardiomyopathy (TTC), pts without structural alteration on CMR and an additional group of healthy control (n=20, 46±8.2y). Standard CMR parameters such as left ventricular ejection fraction (LVEF), end-diastolic and end-systolic (LVESVi) volumes were assessed. We performed CMR-FT analysis of the LV, including: global longitudinal (GLS), circumferential (GCS) and mechanical dispersion (MD).
Results: LVEF was lower (44±9.1%) and LVESVi (52.5±12.9ml/m²) was higher in TTC pts compared to all other groups (p<0.001). The standard CMR parameters did not show significant difference between MI and myocarditis. GLS was significantly reduced in TTC (-11.4±4.8%) compared to all other groups (p<0.001). GCS was impaired in TTC, myocarditis and MI compared to healthy controls (-14±3.7vs-18.7±3.7vs-19.1±3.8vs-23.2±3.1%, p<0.001), however there was no significant difference between myocarditis and MI. MDC was elevated in TTC and MI compared to myocarditis and healthy controls (p<0.05). There was no significant difference between healthy controls and patients without structural alterations in any strain parameter.
Conclusion: Feature tracking analysis may enable differentiation between patients with MINOCA. TTC reduces global myocardial strain of the LV and causes regional heterogeneity of the LV contraction. Although volumetric CMR parameters and global strain values have limited capability to distinguish between MI and myocarditis, regional heterogeneity, expressible in MDC is elevated in MI compared to myocarditis.
Doctoral School of Basic Medicine
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases