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Clinically unrecognized myocardial infarction detected at MR imaging may not be associated with atherosclerosis
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi. (Ahlström)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi. (Ahlström)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för radiologi. (Ahlström)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
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2007 (Engelska)Ingår i: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 245, nr 1, s. 103-110Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: To prospectively investigate whether there is support for the hypothesis that clinically unrecognized myocardial infarctions (UMIs) detected at magnetic resonance (MR) imaging have an atherosclerotic pathogenesis similar to that of recognized myocardial infarctions (RMIs).

Materials and Methods: After ethics committee approval and informed consent were obtained, gadolinium-enhanced whole-body MR angiography and late-enhancement MR imaging were performed in 248 randomly chosen 70-year-old subjects (123 women, 125 men). Imaging included the aorta and the carotid, renal, and lower limb arteries to the ankle, but not the coronary arteries. Subjects with myocardial infarction (MI) scars at late-enhancement MR imaging were classified as having RMI (n = 11) (those with a diagnosis of MI at the hospital) or UMI (n = 49) (those without a diagnosis of MI at the hospital). The presence of 50% or higher luminal narrowing in any vessel at whole-body MR angiography was considered to represent significant atherosclerosis. Intima-media thickness of the common carotid artery was measured with ultrasonography. C-reactive protein level was measured, and coronary heart disease risk was estimated. Observers were blinded to any previous results. The chi(2) test analysis of variance, and Bonferroni correction were used for statistical analyses.

Results: None of the measured parameters differed significantly between the group without MI scars and the UMI group, but parameters were significantly increased in the RMI group (P < .05) compared with those in the group without MI scars. Forty-two of 49 UMIs and nine of 11 RMIs were located within inferolateral segments of the left ventricle.

Conclusion: MR imaging-detected UMIs might have a different pathogenesis from that of RMIs or may have the same pathogenesis but may manifest at an earlier stage.

Ort, förlag, år, upplaga, sidor
2007. Vol. 245, nr 1, s. 103-110
Nyckelord [en]
CORONARY-ARTERY-DISEASE; INTIMA-MEDIA THICKNESS; CARDIOVASCULAR RISK-FACTORS; ST-SEGMENT ELEVATION; C-REACTIVE PROTEIN; MAGNETIC-RESONANCE; ASSESSMENT STRATEGIES; VULNERABLE PATIENT; HEART-DISEASE; CHEST-PAIN
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-95478DOI: 10.1148/radiol.2451061664ISI: 000249577500013OAI: oai:DiVA.org:uu-95478DiVA, id: diva2:169705
Tillgänglig från: 2007-02-23 Skapad: 2007-02-23 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
Ingår i avhandling
1. Myocardial Scars on MRI: Their Prevalence and Possible Impact
Öppna denna publikation i ny flik eller fönster >>Myocardial Scars on MRI: Their Prevalence and Possible Impact
2007 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Myocardial infarction (MI) causes high morbidity and mortality worldwide and for effective prevention and treatment MIs have to be adequately detected.

The existence of clinically unrecognized MIs (UMIs) has been known for the past hundred years, but an ultimate tool for their detection has not yet been found. Using persistent Q waves on electrocardiography as a sign of MI, it has been estimated that UMIs constitute at least ¼ of all MIs and have mortality rates similar to those of recognized MIs (RMIs). These estimates are misleading, however, since persistent Q waves do not necessarily represent MIs.

The late enhancement technique in magnetic resonance imaging (LE MRI) has been developed over the past decade and accurately determines myocardial viability. The aim of this research was to investigate the prevalence and impact of UMI and RMI in a population-based sample of 70-year-olds, assessed with MRI.

Cardiac function and viability were examined with MRI in 259 randomly selected 70-year-old subjects (127 women, 132 men) participating in a larger population-based study (PIVUS). Information on other parameters of cardiovascular disease was obtained and related to the findings.

Three methods for segmentation of the left ventricular mass were used in the first 100 subjects; these differed in accuracy and led to differences in systolic function values. In the subsequent 159 examinations one of the segmentation methods was used.

The viability images were assessable in 248 subjects (123 women, 125 men). Among these, the prevalence of UMI, 19.8%, definitely exceeded the expectations and UMIs constituted 4/5 of all MIs. The prevalence of RMI was 4.4%. MRI-detected UMIs differed from RMIs in several respects; they were smaller, frequently located inferolaterally, did not appear to be associated with atherosclerosis, and displayed increased collagen turnover. The pathogenesis of these UMIs remains to be investigated, but our observations suggest that they are caused by ischemia. Subjects with UMI showed increased cardiac morbidity, a decreased ejection fraction and an increased left ventricular mass, indicating an increased cardiovascular risk.

It is thus important to detect these UMIs, and this is adequately achieved by LE MRI. However, to decide upon prevention and treatment of these UMIs we need to know more about their pathogenesis and prognosis.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2007. s. 89
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 227
Nyckelord
Radiology, magnetic resonance imaging, myocardial infarction, epidemiology, myocardial infarction, epidemiology, Radiologisk forskning
Identifikatorer
urn:nbn:se:uu:diva-7548 (URN)978-91-554-6804-0 (ISBN)
Disputation
2007-03-16, Rudbeckssalen, Rudbeckslaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 09:15
Opponent
Handledare
Tillgänglig från: 2007-02-23 Skapad: 2007-02-23 Senast uppdaterad: 2013-06-20Bibliografiskt granskad

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Ebeling Barbier, CharlotteBjerner, TomasHansen, TomasJohansson, LarsAhlström, Håkan

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