DOI: 10.1161/circ.148.suppl_1.13906 ISSN: 0009-7322

Abstract 13906: Electrocardiographic Correlates of Cardiac MRI Findings in Women With MINOCA

Mitchell Pleasure, Vita Jaspan, Olivia Liu, Emilie Lin, Raymond Kwong, Anais Hausvater, Tara Sedlak, Hayder Hashim, Caitlin Giesler, Kevin R Bainey, Aun-Yeong Chong, Bobak Heydari, Mobeen Ahmed, Nathaniel Smilowitz, Harmony Reynolds
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is identified in 6-15% of patients with MI and disproportionately affects women. Cardiac magnetic resonance (CMR) imaging is important to identify the cause of MINOCA but is restricted by its technical complexity and limited accessibility. The electrocardiogram (ECG), a simple, readily available tool, may predict features associated with abnormal CMR.

Methods: Women with a diagnosis of MI and <50% angiographic stenosis in all epicardial vessels were enrolled in the Women’s Heart Attack Research Program (HARP), a prospective, multicenter, observational study. Participants had CMR at a median of 6 days from MI (n=116). A CMR core laboratory interpreted images while blinded to clinical data and ECGs. Abnormal CMR findings included late gadolinium enhancement (LGE) or myocardial edema. The patient’s presenting ECG was analyzed. ECGs with ≥2 uninterpretable leads or with bundle branch block were excluded. ECGs were assessed for T-wave inversions (TWI), pathologic Q waves (QW), fractionated QRS (fQRS), and ST segment depression or elevation. The DETERMINE score is 2x the number of leads (#) with QW + # fQRS + # TWI, excluding leads V1 and aVR (maximum score 40).

Results: (Figure, Table): Among 112 women with MINOCA, CMR abnormality was more likely in women with DETERMINE score ≥3 vs <3 (86% vs 65%, p = 0.01). DETERMINE score ≥3 was associated with abnormal CMR on logistic regression (OR 3.4, p = 0.01). Patients with any TWI were more likely to have abnormal CMR than those with no TWI (84% vs 64%, p = 0.02), and were more likely to have LGE on CMR (61% vs 34%, p = 0.005). In those with a DETERMINE score of 0, CMR was abnormal in 62% vs 78% with DETERMINE score ≥1 (p=0.09), and LGE was present in 28% vs 54%, p = 0.01.

Conclusion: ECG abnormalities were associated with abnormal CMR among women with MINOCA. The ECG may provide risk stratification for CMR, but the absence of QW, fQRS and TWI does not preclude CMR abnormality.

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