Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2017; 9(3): 268-276
Published online Mar 26, 2017. doi: 10.4330/wjc.v9.i3.268
Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction
Loïc Bière, Marjorie Niro, Hervé Pouliquen, Jean-Baptiste Gourraud, Fabrice Prunier, Alain Furber, Vincent Probst
Loïc Bière, Marjorie Niro, Fabrice Prunier, Alain Furber, Laboratoire Cardioprotection, Institut MITOVASC, Remodelage et Thrombose, Service de Cardiologie, CHU d’Angers, F-49045 Angers, France
Hervé Pouliquen, Jean-Baptiste Gourraud, Vincent Probst, L’institut du Thorax, Service de Cardiologie, CHU de Nantes, F-44000 Nantes, France
Author contributions: Bière L and Niro M contributed equally to this work, generated analysis, and interpretation of the data, and drafted the initial manuscript; Furber A and Probst V were the guarantors of the study; Pouliquen H participated in the acquisition; Gourraud JB and Prunier F revised the article critically for important intellectual content.
Supported by The French Federation of Cardiology (Fédération française de Cardiologie).
Institutional review board statement: The study was reviewed and approved by the ethics committee of the University Hospital of Angers.
Informed consent statement: All patients gave their informed consent for the completion of the study.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Data sharing statement: Technical details and statistical methods are available with the corresponding author at lobiere@chu-anger.fr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Loïc Bière, Laboratoire Cardioprotection, Institut MITOVASC, Remodelage et Thrombose, Service de Cardiologie, CHU d’Angers, Rue Haute de Reculée, F-49045 Angers, France. lobiere@chu-angers.fr
Telephone: +33-241-354858 Fax: +33-241-354004
Received: July 13, 2016
Peer-review started: July 13, 2016
First decision: September 2, 2016
Revised: November 4, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: March 26, 2017
Processing time: 256 Days and 15.5 Hours
Abstract
AIM

To assess the arrhythmic determinants and prognosis of patients presenting with myocardial infarction and non-obstructive coronary arteries (MINOCA) with normal ejection fraction (EF).

METHODS

This is an observational analysis of 131 MINOCA patients with normal EF. Three cardiac magnetic resonance (CMR) diagnosis classes were recognized according to the late gadolinium enhancement (LGE) pattern: Myocardial infarction (MI) (n = 34), myocarditis (n = 47), and “no LGE” (n = 50). Ventricular events occurring during hospitalization were recorded and the entire population was followed-up at 1 year.

RESULTS

Ventricular arrhythmia was observed in 18 (13.8%) patients during hospitalization. The “no LGE” patients experienced fewer ventricular events than the MI and myocarditis patients [4.0% vs 26.5% and 14.9%, respectively (P = 0.013)]. There was no significant difference between the MI and myocarditis groups. On multivariate analysis, LGE transmural extent [OR = 1.52 (1.08-2.15), P = 0.017] and ST-segment elevation [OR = 4.65 (1.61-13.40), P = 0.004] were independent predictors of ventricular arrhythmic events, irrespective of the diagnosis class. Finally, no patient experienced sudden cardiac death or ventricular arrhythmia recurrence at 1-year.

CONCLUSION

MINOCA patients with normal EF presented no 1-year cardiovascular events, irrespective of the CMR diagnosis class. LGE transmural extent and ST segment elevation at admission are risk markers of ventricular arrhythmia during hospitalization.

Keywords: Ventricular tachycardia; Myocarditis; Myocardial infarction; Late gadolinium enhancement; Cardiac magnetic resonance; Myocardial infarction and non-obstructive coronary arteries

Core tip: Out of 131 myocardial infarction and non-obstructive coronary arteries patients, 18 experienced a ventricular arrhythmic event during hospitalization, consisting of 17 ventricular tachycardia and one ventricular fibrillation. No patient died during the 1-year follow-up. Cardiac magnetic resonance classified the underlying diagnosis in 61.8% of the cases, as a myocarditis or a myocardial infarction. Rather than the diagnosis itself, late gadolinium enhancement and ST-segment elevation were found as valuable tools to stratify the risk for arrhythmia of these patients. These findings may be useful to select patients who might be eligible for either arrhythmia prevention or secondary prevention therapy.