P13 Cardiac MRI (CMR) and the ECG in acute coronary syndromes with non-obstructive coronary arteries. (21st September 2022)

• Record Type: Journal Article
• Authors: Thomas, Chloe; Williams, Matthew; Bucciarelli-Ducci, Chiara
• Is Part Of: Heart. Volume 108(2022)Supplement 2
• Page Start: A7
• Page End: A7
• Publication Date: 2022-09-21
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2022-BSCI.18
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Patients presenting with acute coronary syndromes with non-obstructive coronary arteries are increasingly prevalent and challenge clinicians. Currently, diagnosis is aided by cardiac magnetic resonance imaging (CMR). This prospective single centre cohort study aimed to determine whether location of ECG changes correlated with the location of myocardial oedema and fibrosis on CMR, and whether the size of ECG changes correlated with the amount of oedema or fibrosis present. Methods: This prospective study included 71 participants and 27 ST-elevation myocardial infarction (STEMI) patients. ECGs were taken on arrival. A standard CMR protocol was performed during the index admission including T2-weighted short tau-inversion recovery and late gadolinium enhanced imaging. Results: Median age 59 (18); 42% female. Diagnoses on CMR included 56% MI, 15% myocarditis, 11% takotsubo cardiomyopathy, 2% other cardiomyopathy, 16% non-specific. On multivariable regression, both QTc and amount of ST-depression predicted oedema mass on CMR in patients with ACS and non-obstructive coronary arteries (coefficient 0.11; CI 0.16–0.21; p=0.02; coefficient 26.5; CI 15.4–37.6; p<0.001 respectively). QTc interval duration increased with oedema mass in STEMI patients (coefficient=0.27; CI 0.19 – 0.52; p=0.04). The anatomical location of oedema or fibrosis on CMR did not predict the location of ECG changes except for ST elevation and gadolinium position in STEMI patients (p=0.02). Conclusion: Increasing QTc interval and amount of ST depression predict mass of myocardial oedema on CMR in patients with ACS and non-obstructive coronary arteries, while location of myocardial oedema and fibrosis on CMR do not predict location of ST changes seen on the ECG.