Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction

doi:10.4330/wjc.v9.i3.268

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Cardiol. Mar 26, 2017; 9(3): 268-276
Published online Mar 26, 2017. doi: 10.4330/wjc.v9.i3.268

Table 1 Patient characteristics

	All patients (n = 131)	MI (n = 34)	Myocarditis (n = 47)	“No LGE” (n = 50)	P
Age, yr	48.5 ± 16.1	52.4 ± 14.2	40.5 ± 13.5¹	53.4 ± 16.9³	< 0.001
Risk factors, n (%)
Male gender	87 (66.4)	22 (64.7)	39 (83.0)	26 (52.0)²³	0.005
Hypertension	39 (29.8)	13 (38.2)	8 (17.0)	18 (36.0)	0.06
Diabetes	11 (8.4)	4 (11.8)	2 (4.3)	5 (10.0)	0.42
Dyslipidemia	38 (29.0)	9 (26.5)	10 (21.3)	19 (38.0)	0.18
Current smoker	45 (34.4)	14 (41.4)	12 (25.5)	19 (38.0)	0.27
Family history of premature CHD	25 (19.1)	11 (34.2)	5 (10.6)	9 (18.0)	0.05
Time from symptom onset to admission, h	9 [2; 24]	3.5 [2; 13.5]	13 [4; 48]¹	9.5 [2; 24]	0.01
Hospitalization duration, d	6 [4; 7]	5.5 [4; 7]	6 [5; 7]	5 [4; 7]	0.42
ECG monitoring duration, d	5 [4; 6]	5 [4; 6]	5 [4; 7]	4 [3; 6]	0.12
Primary ECG abnormality, n (%)	91 (69.5)	26 (76.5)	34 (72.3)	31 (62.0)	0.32
ST-segment elevation	46 (35.1)	9 (26.5)	22 (46.8)	15 (30.0)	0.10
ST-segment depression	8 (6.1)	2 (5.9)	4 (8.5)	2 (4.0)	0.65
T-wave inversion	31 (23.7)	11 (32.4)	8 (17.0)	12 (24.0)	0.27
Q wave	2 (1.5)	2 (5.9)	0	0	0.06
Atrioventricular block	1 (0.8)	0	0	1 (2.0)	0.28
Laboratory measurements
Peak troponin, μg/L	2.1 ± 5	3.6 ± 6.1	2.9 ± 6.3	0.5 ± 0.6²³	0.013
Leucocytes on admission, G/L	9.3 ± 3.6	9.3 ± 3.9	9.2 ± 3.5	9.2 ± 3.4	0.99
CRP on admission, mg/L	28.2 ± 41.1	8.8 ± 18.9	39.5 ± 38.4¹	31.0 ± 50.4²	0.004
Coronary atheroma, n (%)	45 (34.6)	15 (45.5)	14 (29.8)	16 (32.0)	0.31
β-blocker use, n (%)
During hospitalization	91 (69.5)	27 (79.4)	31 (66.0)	33 (66.0)	0.34
At 1 yr	16 (12.2)	10 (29.4)	1 (2.1)	5 (10.0)	0.05
ACEI use, n (%)
During hospitalization	56 (43.1)	16 (48.5)	16 (34.0)	24 (48.0)	0.29
At 1 yr	17 (13.0)	10 (29.4)	1 (2.1)¹	6 (12.0)	0.042

¹P significant between MI and myocarditis groups;

²P significant between MI and “no LGE” groups;

³P significant between myocarditis and “no LGE” groups. MI: Myocardial infarction; LGE: Late gadolinium enhancement; ACEI: Angiotensin converting enzyme inhibitor; CHD: Coronary heart disease; CRP: C-reactive protein.

Table 2 Cardiac magnetic resonance parameters

	Total (n = 131)	MI (n = 34)	Myocarditis (n = 47)	“no LGE” (n = 50)	P
LVEF (%)	58.6 ± 8.2	57.1 ± 7.8	57.9 ± 8.6	60.2 ± 7.8	0.18
LVEDV (mL)	154.7 ± 37.7	158.8 ± 41	159.6 ± 28.6	147.3 ± 42.1	0.21
LVESV (mL)	64.5 ± 22.1	69.5 ± 25.5	67.1 ± 16.9	58.6 ± 22.9²³	0.048
LV wall thickening abnormality, n (%)	62 (47.3)	30 (88.2)	22 (46.8)¹	10 (20.0)²³	< 0.001
Hypokinetic extent, segments	1.1 ± 1.5	2 ± 1.6	1.2 ± 1.6¹	0.4 ± 1.1²³	< 0.001
0 segment, n (%)	69 (52.7)	4 (11.8)	25 (53.2)	40 (80.0)
1-2 segments, n (%)	43 (32.9)	20 (58.8)	14 (29.8)	9 (18.0)
> 2 segments, n (%)	19 (14.5)	10 (29.4)	8 (17.0)	1 (2.0)
LGE transmural extent, segments	0.9 ± 0.8	3.6 ± 0.6	2.1 ± 0.9¹	0	< 0.001
< 50%, n (%)	83 (73.4)	2 (5.9)	31 (66.0)	0
> 50%, n (%)	48 (36.6)	32 (94.1)	16 (34.0)	0
LGE transversal extent, segments	1.9 ± 2.2	1.9 ± 1.3	3.5 ± 2.4	0²³	< 0.001
0 segment, n (%)	50 (38.2)	0	0	50 (100.0)
1-2 segments, n (%)	46 (35.1)	26 (76.5)	20 (42.6)	0
> 2 segments, n (%)	35 (26.7)	8 (23.5)	27 (57.4)	0
LGE/CINE concordance, n (%)	49 (37.4)	30 (88.2)	19 (41.3)¹	0	< 0.001
Pericardial effusion, n (%)	20 (15.3)	4 (11.8)	8 (17.4)	8 (16)	0.8

¹P significant between MI and myocarditis groups;

²P significant between MI and “no LGE” groups;

³P significant between myocarditis and “no LGE” groups. MI: Myocardial infarction; LGE: Late gadolinium enhancement; LV: Left ventricle; LVEDV: Left ventricular end diastolic volume; LVESV: Left ventricular end systolic volume; LVEF: Left ventricular ejection fraction.

Table 3 Acute event rates

	All patients (n = 131)	MI (n = 34)	Myocarditis (n = 47)	“No LGE” (n = 50)	P
Ventricular event, n (%)	18 (13.8)	9 (26.5)	7 (14.9)	2 (4.0)¹	0.013
VT, n (%)	17 (13.0)	9 (26.5)	6 (12.8)	2 (4.0)¹	0.011
Prolonged VT or VF, n (%)	8 (6.1)	4 (11.8)	4 (8.5)	0¹	0.06
VF, n (%)	1 (0.8)	0	1 (2.1)	0	0.41

¹P significant between MI and “no LGE” groups. MI: Myocardial infarction; LGE: Late gadolinium enhancement; VF: Ventricular fibrillation; VT: Ventricular tachycardia.

Table 4 Acute event characteristics

Patient	Gender	Age (yr)	ECG	Troponin (μg/L)	LVEF (%)	Diagnosis	LGE transmural extent¹	β-blocker use	ACEI use	VT	VF	CMR delay (d)	Ventricular arrhythmia length
13	Male	39	STE	0.3	51.7	MI	4	1	0	1	0	1	10 VPBs
52	Male	45	Normal	0.4	57.7	MI	3	0	0	1	0	1	10 VPBs
53	Female	30	STE	17.3	45.5	MI	4	1	1	1	0	0	30 VPBs
63	Male	51	Normal	0.3	57.8	MI	3	1	1	1	0	1	6 VPBs
64	Male	56	STE	1.6	61.2	MI	4	1	1	1	0	1	15 VPBs
75	Male	32	STE	0.8	63.2	MI	4	1	0	1	0	0	7 VPBs
92	Male	57	STD	0.4	48.1	MI	3	1	0	1	0	0	6 VPBs
128	Female	55	STD	0.6	49.8	MI	4	1	1	1	0	1	5 VPBs
97	Male	83	STD	0.2	46.5	MI	2	1	1	1	0	0	6 VPBs
3	Male	45	STE	0.1	66.9	Myocarditis	3	1	0	1	0	2	9 VPBs
37	Male	40	STE	4.8	56.1	Myocarditis	2	0	1	1	0	2	5 VPBs
44	Male	25	STE	36.6	65.7	Myocarditis	3	0	0	0	1	3	VF
94	Male	28	STE	1.4	57.1	Myocarditis	2	1	0	1	0	0	4 VPBs
76	Male	53	STE	1.4	69.6	Myocarditis	2	1	1	1	0	0	7 VPBs
104	Female	42	STE	21.2	57.1	Myocarditis	4	1	0	1	0	1	13 VPBs
131	Female	31	STD	0.6	51.7	Myocarditis	1	1	0	1	0	1	8 VPBs
80	Male	34	STE	0.4	53.1	No LGE	0	0	1	1	0	0	7 VPBs
125	Male	56	Normal	0.1	62.4	No LGE	0	1	1	1	0	4	3 VPBs

¹LGE transmural extent: 0 = 0%, 1 = 0%-25%, 2 = 25%-50%, 3 = 50%-75%, and 4 > 75%. LGE: Late gadolinium enhancement; ECG: Electrocardiography; LVEF: Left ventricular ejection fraction; STD: ST-segment depression; STE: ST-segment elevation; VT: Ventricular tachycardia; VF: Ventricular fibrillation; VPBs: Ventricular premature beats; MI: Myocardial infarction; ACEI: Angiotensin-converting enzyme inhibitor.

Table 5 Univariate and multivariate analysis for ventricular arrhythmia

	Univariate analysis		Multivariate analysis
	Odds ratio (95%CI)	P	Odds ratio (95%CI)	P
STE	4.65 (1.61-13.40)	0.004	5.72 (1.77-18.46)	0.004
STD	-	0.06
T-wave inversion	-	0.99
Troponin	1.10 (1.02-1.20)	0.02	-	0.27
Hypokinetic extent	-	0.09
LGE transmural extent	1.52 (1.08-2.15)	0.017	1.50 (1.02-2.20)	0.039
LVEF	-	0.31
LVEDV	-	0.3
LVESV	-	0.17
Pericardial effusion	-	0.24
Coronary atheroma	-	0.68
CMR diagnosis	-	0.12
MI or myocarditis	0.17 (0.04-0.77)	0.022

LVEDV: Left ventricular end-diastolic volume; LVESV: Left ventricular end-systolic volume; LVEF: Left ventricular ejection fraction; STD: ST-segment depression; STE: ST-segment elevation; MI: Myocardial infarction; CMR: Cardiac magnetic resonance.

Citation: Bière L, Niro M, Pouliquen H, Gourraud JB, Prunier F, Furber A, Probst V. Risk of ventricular arrhythmia in patients with myocardial infarction and non-obstructive coronary arteries and normal ejection fraction. World J Cardiol 2017; 9(3): 268-276
URL: https://www.wjgnet.com/1949-8462/full/v9/i3/268.htm
DOI: https://dx.doi.org/10.4330/wjc.v9.i3.268