Myocardial infarction and non-obstructive coronary arteries (MINOCA) associated to diastolic dysfunction of the left ventricle

Patients with angina pectoris and demonstrated signs of ischemia but without significant coronary artery disease are at increased risk for major adverse cardiovascular events compared with asymptomatic general population. This syndrome called myocardial infarction and non-obstructive coronary arteries (MINOCA) may have different mechanisms of production. This abnormality was found to be related to abnormal coronary reactivity, micro-vascular coronary dysfunction, and plaque erosion/distal microembolization. However, it remains unclear whether these abnormalities manifest into actual changes in left ventricular (LV) function. Heart failure (HF) with preserved ejection fraction usually affects older women with some cardiovascular risk factors. This diastolic HF is increasingly recognized as a major contributing factor of morbidity and mortality. Multifactorial mechanisms have been implicated such as cardiac hypertrophy, myocardial fibrosis, metabolic dysfunction of cardiomyocytes, and microvascular abnormalities. There is an increasing relatively high incidence of newly onset HF hospitalizations and nonfatal acute coronary syndrome in these patients with MINOCA. It has been demonstrated that LV diastolic dysfunction occurs early in the ischemic cascade and may be a mediator of increased risk of HF and other cardiovascular events among patients with microvascular coronary disease. Therefore, early identification of cardiac abnormalities and diastolic dysfunction with sensitive cardiac MRI tissue tagging techniques provide an important treatment window for preventing disease progression in microvascular coronary disease