Author + information
- Received January 7, 2020
- Accepted February 14, 2020
- Published online September 7, 2020.
- Anaïs Hausvater, MDa,∗,
- Nathaniel R. Smilowitz, MD, MSa,∗,
- Boyangzi Li, MD, PhDb,
- Gabriel Redel-Traub, BS, MDb,
- Mary Quien, MDb,
- Yingzhi Qian, MAc,
- Judy Zhong, PhDc,
- Joseph M. Nicholson, MPHd,
- Giovanni Camastra, MDe,
- Loïc Bière, MDf,
- Roman Panovský, MD, PhDg,
- Montenegro Sá, MDh,
- Edouard Gerbaud, MD, PhDi,j,
- Joseph B. Selvanayagam, MBBS (Hons), DPhilk,
- Mouaz H. Al-Mallah, MD, MScl,
- Tilman Emrich, MDm,n and
- Harmony R. Reynolds, MDa,∗ ()
- aSoter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
- bDepartment of Medicine, New York University School of Medicine, New York, New York
- cDepartment of Population Health, New York University School of Medicine, New York, New York
- dHealth Sciences Library, New York University School of Medicine, New York, New York
- eCardiac Department, Vannini Hospital Rome, Rome, Italy
- fInstitut MITOVASC, Remodelage et Thrombose, Service de Cardiologie, CHU d’Angers, Angers, France
- g1st Department of Internal Medicine/Cardioangiology and International Clinical Research Center, St. Anne’s Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- hDepartment of Cardiology, Centro Hospitalar de Leiria, Leiria, Portugal
- iCardiology Intensive Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, Pessac, France
- jBordeaux Cardio-Thoracic Research Centre, U1045, Bordeaux University, Bordeaux, France
- kDepartment of Cardiovascular Medicine, Flinders University of South Australia, Adelaide, Australia
- lHouston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
- mDepartment of Diagnostic and Interventional Radiology, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany
- nGerman Center for Cardiovascular Research, partner site Rhine-Main, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- ↵∗Address for correspondence:
Dr. Harmony R. Reynolds, Sarah Ross Soter Center for Women’s Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Avenue, SKI-9R, New York, New York 10016.
Objectives The aim of this study was to determine the prevalence of myocarditis among patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA) in relation to the angiographic severity of nonobstructive coronary artery disease (CAD).
Background MINOCA represents about 6% of all cases of acute myocardial infarction. Myocarditis is a diagnosis that may be identified by cardiac magnetic resonance (CMR) imaging in patients with a provisional diagnosis of MINOCA.
Methods A systematic review was performed to identify studies reporting the results of CMR findings in MINOCA patients with nonobstructive CAD or normal coronary arteries. Study-level and individual patient data meta-analyses were performed using fixed- and random-effects methods.
Results Twenty-seven papers were included, with 2,921 patients with MINOCA; CMR findings were reported in 2,866 (98.1%). Myocarditis prevalence was 34.5% (95% confidence interval [CI]: 27.2% to 42.2%) overall and was numerically higher in studies that defined MINOCA as myocardial infarction with angiographically normal coronary arteries compared with a definition that permitted nonobstructive CAD (45.9% vs. 32.3%; p = 0.16). In a meta-analysis of individual patient data from 9 of the 27 studies, the pooled prevalence of CMR-confirmed myocarditis was greater in patients with angiographically normal coronary arteries than in those with nonobstructive CAD (51% [95% CI: 47% to 56%] vs. 23% [95% CI: 18% to 27%]; p < 0.001). Men and younger patients with MINOCA were more likely to have myocarditis. Angiographically normal coronary arteries were associated with increased odds of myocarditis after adjustment for age and sex (adjusted odds ratio: 2.30; 95% CI: 1.12 to 4.71; p = 0.023).
Conclusions Patients with a provisional diagnosis of MINOCA are more likely to have CMR findings consistent with myocarditis if they have angiographically normal coronary arteries.
↵∗ Drs. Hausvater and Smilowitz contributed equally to this work.
Dr. Smilowitz was supported by a New York University Clinical and Translational Science Award (UL1 TR001445 and KL2 TR001446) from the National Center for Advancing Translational Sciences, National Institutes of Health. Dr. Hausvater was supported by a grant from the American Heart Association. Dr. Panovsky was supported by project number LQ1605 from the National Program of Sustainability II (MEYS CR). Dr. Selvanayagam was supported by research grants from Biotronik, Bayer, Sanofi, and Actelion. Dr. Reynolds was supported by the Doris Duke Charitable Foundation (CSDA 2006066). Dr. Selvanagayam is a consultant for Sanofi, Faraday, and Recardio. Dr. Reynolds has received in-kind support for an unrelated research study of MINOCA from Abbott Vascular and Siemens and for an unrelated study of takotsubo syndrome from BioTelemetry, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received January 7, 2020.
- Accepted February 14, 2020.
- 2020 American College of Cardiology Foundation
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