Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical
Abtehale Al-Hussaini1, Ahmed M S E K Abdelaty1,2, Gaurav S Gulsin1
1Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
European Heart Journal
|January 4, 2020
Summary
Spontaneous coronary artery dissection (SCAD) survivors typically have small myocardial injuries and preserved heart function. However, STEMI presentation, poor initial flow, multivessel SCAD, and connective tissue disorders predict larger infarcts.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Spontaneous coronary artery dissection (SCAD) is a cause of myocardial infarction, particularly in young to middle-aged women.
- Understanding the extent of myocardial injury and its impact on cardiac function post-SCAD is crucial for patient management.
- Cardiac magnetic resonance imaging (CMR) provides detailed assessment of myocardial damage and left ventricular function.
Purpose of the Study:
- To quantify myocardial injury extent and distribution using CMR in SCAD survivors.
- To evaluate the impact of SCAD on left ventricular systolic function.
- To identify predictors of significant myocardial injury in SCAD patients.
Main Methods:
- A case-control study involving 158 SCAD survivors and 59 healthy controls, all assessed by CMR.
- Phenotyping included assessment of myocardial infarct size, late gadolinium enhancement (LGE), and left ventricular ejection fraction and dimensions.
- Multivariate logistic regression was used to identify predictors of larger infarcts (>10% LV mass).
Main Results:
- SCAD survivors showed generally preserved left ventricular function, with small reductions in ejection fraction and slight increases in ventricular dimensions compared to controls.
- The majority of SCAD patients had small infarcts (median 4.06% LV mass), with 39% having no detectable LGE.
- Predictors of larger infarcts included ST-elevation myocardial infarction (STEMI) at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4.
Conclusions:
- Most SCAD patients experience limited myocardial infarction and maintain preserved ejection fraction.
- Patients with STEMI, poor initial coronary flow, multivessel SCAD, or features of connective tissue disorders are at higher risk for significant myocardial injury.
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