title: Unrecognized myocardial infarctions assessed by cardiovascular magnetic resonance are associated with the severity of the stenosis in the supplying coronary artery.
abstract: BACKGROUND
  A previous study has shown an increased prevalence of late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) detected unrecognized myocardial infarction (UMI) with increasing extent and severity of coronary artery disease. However, the coronary artery disease was evaluated on a patient level assuming normal coronary anatomy. Therefore, the aims of the present study were to investigate the prevalence of UMI identified by LGE CMR imaging in patients with stable angina pectoris and no known previous myocardial infarction; and to investigate whether presence of UMI is associated with stenotic lesions in the coronary artery supplying the segment of the myocardium in which the UMI is located, using coronary angiography to determine the individual coronary anatomy in each patient.
  
  
  METHODS
  In this prospective multicenter study, we included patients with stable angina pectoris and without prior myocardial infarction, scheduled for coronary angiography. A LGE CMR examination was performed prior to the coronary angiography. The study cohort consisted of 235 patients (80 women, 155 men) with a mean age of 64.8 years.
  
  
  RESULTS
  UMIs were found in 25% of patients. There was a strong association between stenotic lesions (≥70% stenosis) in a coronary artery and the presence of an UMI in the myocardial segments supplied by the stenotic artery; it was significantly more likely to have an UMI downstream a stenosis ≥ 70% as compared to < 70% (OR 5.1, CI 3.1-8.3, p < 0.0001). 56% of the UMIs were located in the inferior and infero-lateral myocardial segments, despite predominance for stenotic lesions in the left anterior descending artery.
  
  
  CONCLUSIONS
  UMI is common in patients with stable angina and the results indicate that the majority of the UMIs are of ischemic origin due to severe coronary atherosclerosis. In contrast to what is seen in recognized myocardial infarctions, UMIs are predominately located in the inferior and infero-lateral myocardial segments.
  
  
  BACKGROUND
  The PUMI study is registered at ClinicalTrials.gov (NCT01257282).
authors.affiliation: Västmanland County Hospital Västerås, Department of Radiology, Västerås, S-72189, Sweden. per.hammar@ltv.se.|Department of Radiology, Oncology and Radiation Science, Uppsala University, S-75185, Uppsala, Sweden. per.hammar@ltv.se.
authors.forename: Per
authors.initials: P
authors.lastname: Hammar
authors.affiliation: Department of Cardiology, Örebro University Hospital, S-70182, Örebro, Sweden. anna.nordenskjold@regionorebrolan.se.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Nordenskjöld
authors.affiliation: Uppsala Clinical Research Centre, S-75237, Uppsala, Sweden. bertil.lindahl@ucr.uu.se.|Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, S-75105, Sweden. bertil.lindahl@ucr.uu.se.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, S-75185, Uppsala, Sweden. olov.duvernoy@radiol.uu.se.
authors.forename: Olov
authors.initials: O
authors.lastname: Duvernoy
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, S-75185, Uppsala, Sweden. hakan.ahlstrom@radiol.uu.se.
authors.forename: Håkan
authors.initials: H
authors.lastname: Ahlström
authors.affiliation: Astra Zeneca, Molndal, Sweden. lars.johansson@radiol.uu.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Johansson
authors.affiliation: Uppsala Clinical Research Centre, S-75237, Uppsala, Sweden. nermin.hadziosmanovic@ucr.uu.se.
authors.forename: Nermin
authors.initials: N
authors.lastname: Hadziosmanovic
authors.affiliation: Department of Radiology, Oncology and Radiation Science, Uppsala University, S-75185, Uppsala, Sweden. tomas.bjerner@radiol.uu.se.
authors.forename: Tomas
authors.initials: T
authors.lastname: Bjerner
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology