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Clinically unrecognized myocardial infarction detected at MR imaging may not be associated with atherosclerosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Ahlström)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Ahlström)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Ahlström)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2007 (English)In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 245, no 1, 103-110 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2007. Vol. 245, no 1, 103-110 p.
Keyword [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
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95478DOI: 10.1148/radiol.2451061664ISI: 000249577500013OAI: oai:DiVA.org:uu-95478DiVA: diva2:169705
Available from: 2007-02-23 Created: 2007-02-23 Last updated: 2012-03-12Bibliographically approved
In thesis
1. Myocardial Scars on MRI: Their Prevalence and Possible Impact
Open this publication in new window or tab >>Myocardial Scars on MRI: Their Prevalence and Possible Impact
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 89 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 227
Keyword
Radiology, magnetic resonance imaging, myocardial infarction, epidemiology, myocardial infarction, epidemiology, Radiologisk forskning
Identifiers
urn:nbn:se:uu:diva-7548 (URN)978-91-554-6804-0 (ISBN)
Public defence
2007-03-16, Rudbeckssalen, Rudbeckslaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 09:15
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Available from: 2007-02-23 Created: 2007-02-23 Last updated: 2013-06-20Bibliographically approved

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

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