PMID- 31898721 OWN - NLM STAT- MEDLINE DCOM- 20210514 LR - 20210514 IS - 1522-9645 (Electronic) IS - 0195-668X (Print) IS - 0195-668X (Linking) VI - 41 IP - 23 DP - 2020 Jun 14 TI - Chronic infarct size after spontaneous coronary artery dissection: implications for pathophysiology and clinical management. PG - 2197-2205 LID - 10.1093/eurheartj/ehz895 [doi] AB - AIMS: To report the extent and distribution of myocardial injury and its impact on left ventricular systolic function with cardiac magnetic resonance imaging (CMR) following spontaneous coronary artery dissection (SCAD) and to investigate predictors of myocardial injury. METHODS AND RESULTS: One hundred and fifty-eight angiographically confirmed SCAD-survivors (98% female) were phenotyped by CMR and compared in a case-control study with 59 (97% female) healthy controls (44.5 +/- 8.4 vs. 45.0 +/- 9.1 years). Spontaneous coronary artery dissection presentation was with non-ST-elevation myocardial infarction in 95 (60.3%), ST-elevation myocardial infarction (STEMI) in 52 (32.7%), and cardiac arrest in 11 (6.9%). Left ventricular function in SCAD-survivors was generally well preserved with small reductions in ejection fraction (57 +/- 7.2% vs. 60 +/- 4.9%, P < 0.01) and increases in left ventricular dimensions (end-diastolic volume: 85 +/- 14 mL/m2 vs. 80 +/- 11 mL/m2, P < 0.05; end-systolic volume: 37 +/- 11 mL/m2 vs. 32 +/- 7 mL/m2, P <0.01) compared to healthy controls. Infarcts were small with few large infarcts (median 4.06%; range 0-30.9%) and 39% having no detectable late gadolinium enhancement (LGE). Female SCAD patients presenting with STEMI had similar sized infarcts to female Type-1 STEMI patients age <75 years. Multivariate modelling demonstrated STEMI at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4 were associated with larger infarcts [>10% left ventricular (LV) mass]. CONCLUSION: The majority of patients presenting with SCAD have no or small infarctions and preserved ejection fraction. Patients presenting with STEMI, TIMI 0/1 flow, multivessel SCAD and those with features of connective tissue disorders are more likely to have larger infarcts. CI - (c) The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. FAU - Al-Hussaini, Abtehale AU - Al-Hussaini A AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Abdelaty, Ahmed M S E K AU - Abdelaty AMSEK AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. AD - Department of Cardiovascular Sciences, Faculty of Medicine, Suez Canal University, km 4.5 Ring road, 41522, Ismailia, Egypt. FAU - Gulsin, Gaurav S AU - Gulsin GS AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Arnold, Jayanth R AU - Arnold JR AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Garcia-Guimaraes, Marcos AU - Garcia-Guimaraes M AD - Department of Cardiology, Hospital Universitario de La Princesa Madrid, Calle Diego de Leon 62, Madrid, Spain. FAU - Premawardhana, Diluka AU - Premawardhana D AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Budgeon, Charley AU - Budgeon C AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Wood, Alice AU - Wood A AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Natarajan, Nalin AU - Natarajan N AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Mangion, Kenneth AU - Mangion K AD - British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK. AD - Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK. FAU - Rakhit, Roby AU - Rakhit R AD - Royal Free Hospital, Pond St, Hampstead, London NW3 2QG, UK. AD - Institute of Cardiovascular Science University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK. FAU - Hoole, Stephen P AU - Hoole SP AD - Royal Papworth Hospital, Papworth Rd, Cambridge CB2 0AY, UK. AD - NIHR Cambridge Biomedical Research Centre, Box 277 Hills Road Cambridge CB2 0QQ, UK. FAU - Johnson, Thomas W AU - Johnson TW AD - Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol BS2 8HW, UK. FAU - Berry, Colin AU - Berry C AD - British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK. AD - Golden Jubilee National Hospital, Agamemnon Street, Clydebank G81 4DY, UK. FAU - Hudson, Ian AU - Hudson I AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Gershlick, Anthony H AU - Gershlick AH AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Ladwiniec, Andrew AU - Ladwiniec A AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Kovac, Jan AU - Kovac J AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Squire, Iain AU - Squire I AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Samani, Nilesh J AU - Samani NJ AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Plein, Sven AU - Plein S AD - Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds LS2 9JT, UK. FAU - McCann, Gerry P AU - McCann GP AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. FAU - Adlam, David AU - Adlam D AD - Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. LA - eng GR - MC_G1002675/MRC_/Medical Research Council/United Kingdom GR - RE/18/6134217/BHF_/British Heart Foundation/United Kingdom GR - CH/16/2/32089/BHF_/British Heart Foundation/United Kingdom GR - 32190/BHF_/British Heart Foundation/United Kingdom GR - FS/16/47/32190/BHF_/British Heart Foundation/United Kingdom GR - FS/15/54/31639/BHF_/British Heart Foundation/United Kingdom GR - PG/13/96/30608/BHF_/British Heart Foundation/United Kingdom GR - PG/18/42/33746/BHF_/British Heart Foundation/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Eur Heart J JT - European heart journal JID - 8006263 RN - 0 (Contrast Media) RN - AU0V1LM3JT (Gadolinium) SB - IM CIN - Eur Heart J. 2020 Jun 14;41(23):2206-2208. PMID: 32031604 CIN - Eur Heart J. 2020 Jun 14;41(23):2220. PMID: 32300783 MH - Aged MH - Case-Control Studies MH - Contrast Media MH - Coronary Vessels MH - Dissection MH - Female MH - Gadolinium MH - Humans MH - Male MH - *Percutaneous Coronary Intervention MH - *ST Elevation Myocardial Infarction/diagnostic imaging MH - Ventricular Function, Left PMC - PMC7299635 OTO - NOTNLM OT - Cardiac magnetic resonance imaging OT - Spontaneous coronary artery dissection EDAT- 2020/01/04 06:00 MHDA- 2021/05/15 06:00 PMCR- 2020/01/03 CRDT- 2020/01/04 06:00 PHST- 2019/08/20 00:00 [received] PHST- 2019/10/29 00:00 [revised] PHST- 2019/12/09 00:00 [accepted] PHST- 2020/01/04 06:00 [pubmed] PHST- 2021/05/15 06:00 [medline] PHST- 2020/01/04 06:00 [entrez] PHST- 2020/01/03 00:00 [pmc-release] AID - 5695526 [pii] AID - ehz895 [pii] AID - 10.1093/eurheartj/ehz895 [doi] PST - ppublish SO - Eur Heart J. 2020 Jun 14;41(23):2197-2205. doi: 10.1093/eurheartj/ehz895.