Key result
Myocarditis, MINOCA, and Takotsubo linked to ~11-HU higher pericoronary fat attenuation vs controls.
Why the study?
High-sensitivity cardiac troponin identifies patients with chest pain, ECG changes suggestive of MI, and nonobstructive coronary artery disease, but the value and time course of pericoronary fat inflammation in these conditions remained uncharacterized.
Does acute myocardial injury with nonobstructive coronary arteries increase perivascular fat inflammation in patients compared to healthy controls?
Observational (n=50)
No
Does acute myocardial injury with nonobstructive coronary arteries increase perivascular fat inflammation in patients compared to healthy controls?
This study highlights that MINOCA is associated with acute, transient coronary inflammation identifiable by pericoronary fat attenuation on CT, differentiating its pathophysiology from myocarditis and TTS.
Answers are grounded in this paper and cite their sources.
May indicate perivascular inflammation in these syndromes; hypothesis-generating and requires prospective validation before clinical adoption.
The introduction of high-sensitivity cardiac troponin allowed identifying a proportion of subjects with chest pain and electrocardiographic changes suggestive of myocardial infarction showing <50% coronary artery stenosis. PFAI is a coronary CT marker proved to predict outcome in ischemic heart disease. Based on CMR findings, patients were divided into myocarditis (n = 15), MINOCA (n = 14) and TTS (n = 9) groups. The aim was to estimate the value of pFAI in these groups compared to 12 controls. To evaluate the coronary inflammation “time course,” 20 patients underwent CMR and coronary CT scan within 8 days from the onset, the others within 60 days. There were higher values of pFAI in myocarditis (−86.45 HU), MINOCA (−84.63 HU) and TTS (−84.79 HU) compared to controls (−96.02 HU; p = 0.0077). Among patients who underwent CT within 8 days from onset, the MINOCA had a significantly higher pFAI value (−76.91 HU) compared to the control group (−96.02 HU; p = 0.0001). In the group that underwent CT later than 8 days, elevated pFAI values persisted only in the myocarditis and TTS groups, and there was no difference between MINOCA and controls. Our study shows that in patients with a diagnosis of MINOCA, there is acute coronary inflammation, which is more evident within one week from the acute event but tends to disappear with time.
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Pergola et al. (2021) conducted an observational in Myocardial damage with nonobstructive coronary arteries (Myocarditis, MINOCA, TTS) (n=50). Myocardial injury with nonobstructive coronary arteries vs. Healthy subjects with atypical chest pain and normal or mild coronary atherosclerosis was evaluated on Perivascular fat attenuation index (pFAI) via CCT (p=0.0077). Patients with myocarditis, MINOCA, and Takotsubo syndrome exhibited higher pericoronary fat attenuation index values compared to healthy controls.
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