Key result
Cardiac MRI detects unrecognized myocardial infarction in only ~0.2% of asymptomatic middle-aged adults.
Cross-Sectional (n=1,529)
No
In a predominantly middle-aged, asymptomatic cohort with low-to-intermediate cardiovascular risk, the prevalence of unrecognized myocardial infarction detected by CMR is extremely low (0.2%).
Low UMI prevalence by CMR in low-risk asymptomatic adults; challenges prior 19-30% estimates from unselected cohorts and leaves open screening value in higher-risk groups.
AIMS: Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI). METHODS AND RESULTS: A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m2, P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function. CONCLUSION: Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.
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Weir‐McCall et al. (2016) conducted a cross-sectional in Asymptomatic, low-intermediate cardiovascular risk (n=1,529). Cardiac magnetic resonance imaging (CMR) screening was evaluated on Prevalence of unrecognized myocardial infarction (UMI). In a predominantly middle-aged, asymptomatic cohort with low-to-intermediate cardiovascular risk, the prevalence of unrecognized myocardial infarction detected by cardiac MRI was very low at 0.2%.
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