CMR - MINOCA

The Incremental Role of Cardiac Magnetic Resonance Imaging in Myocardial Infarction with Non-Obstructive Coronary Arteries

Summary

Background

90% of heart attacks are caused by blocked or narrowed heart arteries. However up to 10% ofpatients do not have a primary problem with their heart arteries. These patients are now classified ashaving 'MINOCA' (myocardial infarction with non-obstructive coronary arteries). These patients werethought to be low risk and were often discharged with no treatment or follow up. However, they havea 12-month mortality approaching 5%. The majority of these patients have one of three conditions:inflammation of the heart (myocarditis), stress cardiomyopathy (takotsubo cardiomyopathy) or a missed heart attack. Cardiac MRI is very good at identifying between these causes.
There is a link between the heart and brain and this is a very 'hot topic' in cardiology at the moment (see BBC news article 5th March 2019 "Brain clue to 'broken heart' syndrome'). It has also been shown in small, retrospective studies that patients who have stress cardiomyopathy have certain structural and functional differences in their brain compared to people who do not develop this condition in response to stress. As an additional sub-study, we will be performing functional brain MRI at the time of cardiac MRI in our participants to study this prospectively for the first time.

Study design

We are offering patients sequential cardiac and brain MRI scanning, blood tests and psychological testing as an inpatient, at 6 weeks and at 6 months.
We will look for changes in clinician's diagnosis before and after cardiac MRI and the psychological, anatomical and functional differences between patients with takotsubo cardiomyopathy and control patients. This will help tailor treatments to each patient and improve patient experience and outcomes.