title: Myocarditis or "true" infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data.
abstract: OBJECTIVE
  Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) is common, but the causes are to a large extent unknown. Thus, we aimed to study the prevalence of myocarditis and "true" myocardial infarction determined by cardiac magnetic resonance (CMR) imaging in MINOCA patients, and risk markers for these two conditions in this population.
  
  
  METHODS
  A search was made in the PubMed and Cochrane databases using the search terms "Myocardial infarction", "Coronary angiography", "Normal coronary arteries" and "MRI". All relevant abstracts were read and seven of the studies fulfilled the inclusion criteria; studies describing case series of patients fulfilling the diagnosis of acute myocardial infarction with normal or non-obstructive coronary arteries on coronary angiography that were investigated with CMR imaging. Data from five of these studies are presented.
  
  
  RESULTS
  A total of 556 patients from 5 different sites were included. Fifty-one percent were men with a mean age of 52 ± 16 years. Thirty-three per cent of the patients had myocarditis (n = 183), whereas 21% of the patients had infarction on CMR (n = 115). Young age and a high CRP were associated with myocarditis whereas male sex, treated hyperlipidemia, high troponin ratio and low CRP were associated with "true" myocardial infarction.
  
  
  CONCLUSIONS
  The results of this meta-analysis of individual data showed that myocarditis and "true" myocardial infarction are common in MINOCA when determined by CMR imaging. This information emphasizes the importance of performing CMR imaging in MINOCA patients and can be used clinically to guide diagnostics and treatment of MINOCA patients.
authors.affiliation: Cardiology Unit, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sweden. Electronic address: per.tornvall@ki.se.
authors.forename: P
authors.initials: P
authors.lastname: Tornvall
authors.affiliation: Soins Intensifs Cardiologiques, Plateau de Cardiologie Interventionnelle, CHU de Bordeaux, Hôpital du Haut Lévêque, 5 Avenue de Magellan, F33604 Pessac, France.
authors.forename: E
authors.initials: E
authors.lastname: Gerbaud
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, INSERM, U1099, Université de Rennes 1, LTSI, Rennes, France.
authors.forename: A
authors.initials: A
authors.lastname: Behaghel
authors.affiliation: Department of Cardiology, EA 3920, University Hospital Jean Minjoz, 25000 Besancon, France.
authors.forename: R
authors.initials: R
authors.lastname: Chopard
authors.affiliation: Cardiology Unit, Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Collste
authors.affiliation: Hospital Galdakao, Vizcaya, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Laraudogoitia
authors.affiliation: CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, INSERM, U1099, Université de Rennes 1, LTSI, Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Leurent
authors.affiliation: Department of Cardiology, EA 3920, University Hospital Jean Minjoz, 25000 Besancon, France.
authors.forename: N
authors.initials: N
authors.lastname: Meneveau
authors.affiliation: Unité d'Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, Hôpital du Haut Lévêque, 5 Avenue de Magellan, F33604 Pessac, France.
authors.forename: M
authors.initials: M
authors.lastname: Montaudon
authors.affiliation: Hospital Gregorio Marañon Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Perez-David
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Sörensson
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Agewall
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D009205:Myocarditis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Cardiac magnetic resonance imaging; Infarction; Myocardial infarction; Myocarditis; Normal coronary angiography