DOI QR코드

DOI QR Code

Troponin-Positive Non-Obstructive Coronary Arteries and Myocardial Infarction with Non-Obstructive Coronary Arteries: Definition, Etiologies, and Role of CT and MR Imaging

  • Seung Min Yoo (Department of Radiology, CHA University Bundang Medical Center) ;
  • Sowon Jang (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Jeong A Kim (Department of Radiology, Yonsei University Yongin Severance Hospital) ;
  • Eun Ju Chun (Department of Radiology, Seoul National University Bundang Hospital)
  • 투고 : 2020.01.29
  • 심사 : 2020.04.22
  • 발행 : 2020.12.01

초록

In approximately 10% of patients with acute myocardial infarction (MI), angiography does not reveal an obstructive coronary stenosis. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA), which has complex and multifactorial causes. However, this term can be confusing and open to dual interpretation, because MINOCA is also used to describe patients with acute myocardial injury caused by ischemia-related myocardial necrosis. Therefore, with regards to this specific context of MINOCA, the generic term for MINOCA should be replaced with troponin-positive with non-obstructive coronary arteries (TpNOCA). The causes of TpNOCA can be subcategorized into epicardial coronary (causes of MINOCA), myocardial, and extracardiac disorders. Cardiac magnetic resonance imaging can confirm MI and differentiate various myocardial causes, while cardiac computed tomography is useful to diagnose the extracardiac causes.

키워드

참고문헌

  1. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018;72:2231-2264 https://doi.org/10.1016/j.jacc.2018.08.1038
  2. Stensaeth KH, Fossum E, Hoffmann P, Mangschau A, Klow NE. Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries. Int J Cardiovasc Imaging 2011;27:355-365 https://doi.org/10.1007/s10554-010-9671-7
  3. Pasupathy S, Tavella R, Beltrame JF. Myocardial infarction with nonobstructive coronary arteries (MINOCA): the past, present, and future management. Circulation 2017;135:1490-1493 https://doi.org/10.1161/CIRCULATIONAHA.117.027666
  4. Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2017;38:143-153
  5. Pasupathy S, Tavella R, Beltrame JF. The what, when, who, why, how and where of myocardial infarction with non-obstructive coronary arteries (MINOCA). Circ J 2016;80:11-16 https://doi.org/10.1253/circj.CJ-15-1096
  6. Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J 2011;32:404-411 https://doi.org/10.1093/eurheartj/ehq456
  7. Scalone G, Niccoli G, Crea F. Editor's choice- pathophysiology, diagnosis and management of MINOCA: an update. Eur Heart J Acute Cardiovasc Care 2019;8:54-62 https://doi.org/10.1177/2048872618782414
  8. Song JK, Lee SJ, Kang DH, Cheong SS, Hong MK, Kim JJ, et al. Ergonovine echocardiography as a screening test for diagnosis of vasospastic angina before coronary angiography. J Am Coll Cardiol 1996;27:1156-1161 https://doi.org/10.1016/0735-1097(95)00590-0
  9. Dastidar AG, Baritussio A, De Garate E, Drobni Z, Biglino G, Singhal P, et al. Prognostic role of CMR and conventional risk factors in myocardial infarction with nonobstructed coronary arteries. JACC Cardiovasc Imaging 2019;12:1973-1982 https://doi.org/10.1016/j.jcmg.2018.12.023
  10. Yoo SM, Chun EJ, Lee HY, Min D, White CS. Computed tomography diagnosis of nonspecific acute chest pain in the emergency department: from typical acute coronary syndrome to various unusual mimics. J Thorac Imaging 2017;32:26-35 https://doi.org/10.1097/RTI.0000000000000241
  11. Reynolds HR, Srichai MB, Iqbal SN, Slater JN, Mancini GB, Feit F, et al. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation 2011;124:1414-1425 https://doi.org/10.1161/CIRCULATIONAHA.111.026542
  12. Iqbal SN, Feit F, Mancini GB, Wood D, Patel R, Pena-Sing I, et al. Characteristics of plaque disruption by intravascular ultrasound in women presenting with myocardial infarction without obstructive coronary artery disease. Am Heart J 2014;167:715-722 https://doi.org/10.1016/j.ahj.2014.01.011
  13. Niccoli G, Scalone G, Crea F. Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management. Eur Heart J 2015;36:475-481 https://doi.org/10.1093/eurheartj/ehu469
  14. Lee HY, Yoo SM. A case of paradoxical air embolism in the coronary artery through a patent foramen ovale demonstrated by coronary CT angiography. Clin Imaging 2013;37:167-169 https://doi.org/10.1016/j.clinimag.2012.04.001
  15. Jin KN, Chun EJ, Choi SI, Ko SM, Han MK, Bae HJ, et al. Cardioembolic origin in patients with embolic stroke: spectrum of imaging findings on cardiac MDCT. AJR Am J Roentgenol 2010;195:W38-W44 https://doi.org/10.2214/AJR.09.3218
  16. Sharma S, Kaadan MI, Duran JM, Ponzini F, Mishra S, Tsiaras SV, et al. Risk factors, imaging findings, and sex differences in spontaneous coronary artery dissection. Am J Cardiol 2019;123:1783-1787 https://doi.org/10.1016/j.amjcard.2019.02.040
  17. Agrawal V, Kim ESH. Spontaneous coronary artery dissection: cardiac manifestations of vascular disease. Prog Cardiovasc Dis 2018;60:629-634 https://doi.org/10.1016/j.pcad.2018.04.001
  18. Lerman A, Kwon TG, Lerman LO. Morphological characteristics of coronary arteries in patients with vasospastic angina: another form of atherosclerosis? JACC Cardiovasc Imaging 2015;8:1068-1070 https://doi.org/10.1016/j.jcmg.2015.05.008
  19. Park HC, Shin JH, Jeong WK, Choi SI, Kim SG. Comparison of morphologic findings obtained by optical coherence tomography in acute coronary syndrome caused by vasospasm and chronic stable variant angina. Int J Cardiovasc Imaging 2015;31:229-237 https://doi.org/10.1007/s10554-014-0543-4
  20. Shin ES, Ann SH, Singh GB, Lim KH, Yoon HJ, Hur SH, et al. OCT-defined morphological characteristics of coronary artery spasm sites in vasospastic angina. JACC Cardiovasc Imaging 2015;8:1059-1067 https://doi.org/10.1016/j.jcmg.2015.03.010
  21. Kang KM, Choi SI, Chun EJ, Kim JA, Youn TJ, Choi DJ. Coronary vasospastic angina: assessment by multidetector CT coronary angiography. Korean J Radiol 2012;13:27-33 https://doi.org/10.3348/kjr.2012.13.1.27
  22. Park J, Kim HK, Park EA, Park JB, Lee SP, Lee W, et al. Coronary computed tomography angiography for the diagnosis of vasospastic angina: comparison with invasive coronary angiography and ergonovine provocation test. Korean J Radiol 2019;20:719-728 https://doi.org/10.3348/kjr.2018.0847
  23. Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, et al. Cardiovascular magnetic resonance in nonischemic myocardial inflammation: expert recommendations. J Am Coll Cardiol 2018;72:3158-3176 https://doi.org/10.1016/j.jacc.2018.09.072
  24. Bouleti C, Baudry G, Iung B, Arangalage D, Abtan J, Ducrocq G, et al. Usefulness of late iodine enhancement on spectral CT in acute myocarditis. JACC Cardiovasc Imaging 2017;10:826-827 https://doi.org/10.1016/j.jcmg.2016.09.013
  25. Lee HJ, Im DJ, Youn JC, Chang S, Suh YJ, Hong YJ, et al. Assessment of myocardial delayed enhancement with cardiac computed tomography in cardiomyopathies: a prospective comparison with delayed enhancement cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2017;33:577-584 https://doi.org/10.1007/s10554-016-1024-8
  26. Dastidar AG, Rodrigues JC, Ahmed N, Baritussio A, Bucciarelli-Ducci C. The role of cardiac MRI in patients with troponin-positive chest pain and unobstructed coronary arteries. Curr Cardiovasc Imaging Rep 2015;8:28 https://doi.org/10.1007/s12410-015-9345-x
  27. Madhavan M, Rihal CS, Lerman A, Prasad A. Acute heart failure in apical ballooning syndrome (Tako Tsubo/stress cardiomyopathy): clinical correlates and Mayo clinic risk score. J Am Coll Cardiol 2011;57:1400-1401 https://doi.org/10.1016/j.jacc.2010.10.038
  28. Perazzolo Marra M, Zorzi A, Corbetti F, De Lazzari M, Migliore F, Tona F, et al. Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens' ECG pattern) in Tako-Tsubo cardiomyopathy. Heart Rhythm 2013;10:70-77 https://doi.org/10.1016/j.hrthm.2012.09.004
  29. Avegliano G, Huguet M, Costabel JP, Ronderos R, Bijnens B, Kuschnir P, et al. Morphologic pattern of late gadolinium enhancement in Takotsubo cardiomyopathy detected by early cardiovascular magnetic resonance. Clin Cardiol 2011;34:178-182 https://doi.org/10.1002/clc.20877
  30. Mahmoudi M, Harden S, Abid N, Peebles C, Nicholas Z, Jones T, et al. Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI. Br J Radiol 2012;85:e461-e466 https://doi.org/10.1259/bjr/90663866
  31. Monney PA, Sekhri N, Burchell T, Knight C, Davies C, Deaner A, et al. Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis. Heart 2011;97:1312-1318 https://doi.org/10.1136/hrt.2010.204818
  32. Di Nisio M, van Es N, Buller HR. Deep vein thrombosis and pulmonary embolism. Lancet 2016;388:3060-3073 https://doi.org/10.1016/S0140-6736(16)30514-1
  33. Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018;8:225-243 https://doi.org/10.21037/cdt.2017.12.01
  34. Lim W, Qushmaq I, Devereaux PJ, Heels-Ansdell D, Lauzier F, Ismaila AS, et al. Elevated cardiac troponin measurements in critically ill patients. Arch Intern Med 2006;166:2446-2454 https://doi.org/10.1001/archinte.166.22.2446
  35. Jensen JK, Kristensen SR, Bak S, Atar D, Hoilund-Carlsen PF, Mickley H. Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol 2007;99:108-112 https://doi.org/10.1016/j.amjcard.2006.07.071
  36. Masuda T, Sato K, Yamamoto S, Matsuyama N, Shimohama T, Matsunaga A, et al. Sympathetic nervous activity and myocardial damage immediately after subarachnoid hemorrhage in a unique animal model. Stroke 2002;33:1671-1676 https://doi.org/10.1161/01.STR.0000016327.74392.02