Strain Echocardiography in MINOCA: Diagnostic and Follow-Up Implications

Q: What are the key findings of this study?

In MINOCA patients, 3-month LV-GLS impairment persisted at levels comparable to MIOCA (-14.87% vs. -15.27%, p=0.29) despite higher preserved LVEF (62.0% vs. 57.5%, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction with non-obstructive coronary arteries (MINOCA) and acute coronary syndrome (ACS) (n=337). Intervention: Myocardial infarction with non-obstructive coronary arteries (MINOCA) evaluated by speckle-tracking echocardiography (LV-GLS) vs. Myocardial infarction with obstructive coronary arteries (MIOCA; ≥50% stenosis, n=237) and ischemic control group without obstructive disease (INOCA, n=50). Primary outcome: Left ventricular global longitudinal strain (LV-GLS, %) at 3-month follow-up (p=0.29).

Q: What does this research mean for the field?

Patients with MINOCA exhibit persistent subclinical myocardial dysfunction at three months comparable to MIOCA patients as measured by impaired LV-GLS, despite maintaining higher preserved ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mustafa Lütfi Yavuz; Pelin Karaca Özer; Elif Ayduk Gövdeli; Mehmet Aydoğan; Mehmet Akif Parlar; Samim Emet; Ali Elitok; Fehmi Mercanoğlu

doi:10.3390/jcm15134934

June 25, 2026Journal of Clinical MedicineOpen Access

Strain Echocardiography in MINOCA: Diagnostic and Follow-Up Implications

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Key result

MINOCA patients show persistent 3-month LV-GLS impairment comparable to MIOCA despite preserved LVEF.

P=0.29
n=337

Figures

Why the study?

MINOCA represents a heterogeneous clinical entity, and this study aimed to evaluate the diagnostic and follow-up value of LV-GLS and its association with inflammatory and glycemic biomarkers.

Does left ventricular global longitudinal strain (LV-GLS) detect subclinical myocardial dysfunction and correlate with inflammatory and glycemic biomarkers over a 3-month follow-up in patients with MINOCA compared to MIOCA and INOCA?

Study Design

Type

Cohort (n=337)

Multicenter

No

Structured PICO

Does left ventricular global longitudinal strain (LV-GLS) detect subclinical myocardial dysfunction and correlate with inflammatory and glycemic biomarkers over a 3-month follow-up in patients with MINOCA compared to MIOCA and INOCA?

P

Population

337 adults (mean age 56.9 years, 28.8% female) including 287 consecutive ACS patients (50 MINOCA, 237 MIOCA) and 50 INOCA controls at a single center in Turkey, followed for 3 months.

E

Exposure

Transthoracic echocardiography (TTE) with speckle-tracking assessment of left ventricular global longitudinal strain (LV-GLS) using Siemens Velocity Vector Imaging (VVI) software and laboratory biomarker assessment (glucose, CRP, lipid profile, HbA1c, troponin, complete blood count, NLR, NPR, PLR) at baseline and 3-month follow-up.

C

Comparator

Comparison of MINOCA patients (n=50, <50% coronary stenosis) against MIOCA patients (n=237, >=50% coronary stenosis) and a non-ACS control group with ischemia and no obstructive coronary artery disease (INOCA, n=50).

O

Outcome

Left ventricular global longitudinal strain (LV-GLS) and left ventricular ejection fraction (LVEF) at baseline and at 3-month follow-up.surrogate

Main Result

Absolute Event Rate: -14.87% vs -15.27%

p-value: p=0.29

In patients with MINOCA, left ventricular global longitudinal strain (LV-GLS) detects persistent subclinical myocardial dysfunction at 3 months despite preserved LVEF, with admission glucose and neutrophil-to-platelet ratio independently predicting strain impairment.

Limitations

Prospective observational design prevents definitive establishment of causal relationships.
Relatively small sample size, particularly in the MINOCA subgroup (n=50), limiting generalizability and stability of multivariable regression analyses.
Advanced diagnostic modalities such as routine cardiac MRI (CMR), OCT, vasospasm provocation testing, and FFR were not systematically performed in all patients.
Detailed therapeutic strategies and long-term prognostic outcomes were not systematically evaluated.
ROC-derived cut-off values were not externally validated, and LV-GLS values may be influenced by vendor-specific software.
Prospective observational design prevents definitive establishment of causal relationships
Relatively small sample size, particularly in the MINOCA subgroup (n=50), limiting generalizability and stability of multivariable regression analyses
Lack of systematic advanced diagnostic modalities such as routine cardiac magnetic resonance imaging (CMR), intravascular imaging (OCT), vasospasm provocation testing, and physiological assessment (FFR)
Detailed therapeutic strategies and long-term prognostic outcomes were not systematically evaluated
ROC-derived cut-off values were not externally validated, and absolute LV-GLS values may be influenced by vendor-specific software

Implication

LV-GLS may identify persistent subclinical dysfunction in MINOCA despite preserved LVEF; leaves open whether routine strain assessment improves risk stratification or outcomes.

Abstract

Background/Objectives: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity in which patients exhibit symptoms and biomarker evidence of myocardial infarction despite the absence of significant coronary stenosis. This study aimed to evaluate the diagnostic and follow-up value of left ventricular global longitudinal strain (LV-GLS) in patients with MINOCA and to investigate its association with inflammatory and glycemic biomarkers. Methods: A total of 287 patients presenting with acute coronary syndrome were prospectively enrolled. Based on coronary angiographic findings, patients were classified into two groups: myocardial infarction with obstructive coronary arteries (MIOCA; ≥50% stenosis, n = 237) and MINOCA (<50% stenosis, n = 50). In addition, an ischemic control group without obstructive disease (INOCA, n = 50) was included for comparative analysis. Laboratory tests, echocardiography, and LV-GLS were assessed at baseline and at 3 months. Results: Baseline left ventricular ejection fraction (LVEF) and LV-GLS were significantly lower in MIOCA compared with MINOCA (LVEF: 52.9 ± 10.3% vs. 59.7 ± 8.7%, p < 0.001; LV-GLS: −11.46 ± 4.84% vs. −12.63 ± 6.33%, p = 0.007, respectively). At 3 months, LVEF remained lower in the MIOCA group (57.5 ± 6.6% vs. 62.0 ± 7.9%; p < 0.001, respectively), whereas LV-GLS improved similarly in both groups with no significant difference (−15.27 ± 2.60% vs. −14.87 ± 5.21%; p = 0.29, respectively). Among MINOCA patients, the neutrophil-to-platelet ratio (NPR) (p = 0.017) and admission glucose (p = 0.047) were independently associated with impaired LV-GLS (defined as values greater than −16%). Conclusions: Although LVEF remained higher in MINOCA patients during follow-up, LV-GLS impairment persisted at levels comparable to those observed in MIOCA, suggesting ongoing subclinical myocardial dysfunction. LV-GLS offers superior diagnostic sensitivity to LVEF. Inflammatory and glycemic markers may aid in early risk stratification and guide management in patients with MINOCA.

Discussion

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Cite This Study

Yavuz et al. (2026) conducted a cohort in Myocardial infarction with non-obstructive coronary arteries (MINOCA) and acute coronary syndrome (ACS) (n=337). Myocardial infarction with non-obstructive coronary arteries (MINOCA) evaluated by speckle-tracking echocardiography (LV-GLS) vs. Myocardial infarction with obstructive coronary arteries (MIOCA; ≥50% stenosis, n=237) and ischemic control group without obstructive disease (INOCA, n=50) was evaluated on Left ventricular global longitudinal strain (LV-GLS, %) at 3-month follow-up (p=0.29). In MINOCA patients, 3-month LV-GLS impairment persisted at levels comparable to MIOCA (-14.87% vs. -15.27%, p=0.29) despite higher preserved LVEF (62.0% vs. 57.5%, p<0.001).

synapsesocial.com/papers/6a3f6922aea7db3c1953fff5 https://doi.org/10.3390/jcm15134934

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Strain Echocardiography in MINOCA: Diagnostic and Follow-Up Implications

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Strain Echocardiography in MINOCA: Diagnostic and Follow-Up Implications

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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