Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis

Jonathan R. Weir-McCall; Kerrie Fitzgerald; Carla J. Papagiorcopulo; Stephen J. Gandy; Matthew Lambert; Jill J. F. Belch; Ian Cavin; Roberta Littleford; Jennifer A. Macfarlane; Shona Z. Matthew; R. Stephen Nicholas; Allan D. Struthers; Frank M. Sullivan; Shelley A. Waugh; Richard D. White; J. Graeme Houston

doi:10.1093/ehjci/jew155

Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis

Jonathan R. Weir-McCall, Kerrie Fitzgerald, Carla J. Papagiorcopulo, Stephen J. Gandy, Matthew Lambert, Jill J. F. Belch, Ian Cavin, Roberta Littleford, Jennifer A. Macfarlane, Shona Z. Matthew, R. Stephen Nicholas, Allan D. Struthers, Frank M. Sullivan, Shelley A. Waugh, Richard D. White, J. Graeme Houston

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Aims: Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI).

Methods and Results: A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m(2), P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function.

Conclusion: Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.

Original language	English
Number of pages	6
Journal	European Heart Journal - Cardiovascular Imaging
DOIs	https://doi.org/10.1093/ehjci/jew155
Publication status	Published - 22 Aug 2016

Keywords

Myocardial infarction
Whole-body MRI
Cardiac magnetic resonance
Atherosclerosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Sullivan_2016_EHJCI_MyocardialInfarction_CC
© The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 124 KBLicence: CC BY

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Weir-McCall, J. R., Fitzgerald, K., Papagiorcopulo, C. J., Gandy, S. J., Lambert, M., Belch, J. J. F., Cavin, I., Littleford, R., Macfarlane, J. A., Matthew, S. Z., Nicholas, R. S., Struthers, A. D., Sullivan, F. M., Waugh, S. A., White, R. D., & Houston, J. G. (2016). Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis. European Heart Journal - Cardiovascular Imaging. https://doi.org/10.1093/ehjci/jew155

@article{279aa82be38c458ea3eaa04908d01161,

title = "Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis",

abstract = "Aims: Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI).Methods and Results: A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m(2), P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function.Conclusion: Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.",

keywords = "Myocardial infarction, Whole-body MRI, Cardiac magnetic resonance, Atherosclerosis",

author = "Weir-McCall, {Jonathan R.} and Kerrie Fitzgerald and Papagiorcopulo, {Carla J.} and Gandy, {Stephen J.} and Matthew Lambert and Belch, {Jill J. F.} and Ian Cavin and Roberta Littleford and Macfarlane, {Jennifer A.} and Matthew, {Shona Z.} and Nicholas, {R. Stephen} and Struthers, {Allan D.} and Sullivan, {Frank M.} and Waugh, {Shelley A.} and White, {Richard D.} and Houston, {J. Graeme}",

note = "The study was funded by the Souter Charitable Foundation and the Chest, Heart and Stroke Scotland Charity. J.R.W.M. is supported by the Wellcome Trust through the Scottish Translational Medicine and Therapeutics Initiative (grant no. WT 085664) in the form of a clinical research fellowship.",

year = "2016",

month = aug,

day = "22",

doi = "10.1093/ehjci/jew155",

language = "English",

journal = "European Heart Journal - Cardiovascular Imaging",

issn = "2047-2404",

publisher = "Oxford University Press",

}

Weir-McCall, JR, Fitzgerald, K, Papagiorcopulo, CJ, Gandy, SJ, Lambert, M, Belch, JJF, Cavin, I, Littleford, R, Macfarlane, JA, Matthew, SZ, Nicholas, RS, Struthers, AD, Sullivan, FM, Waugh, SA, White, RD & Houston, JG 2016, 'Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis', European Heart Journal - Cardiovascular Imaging. https://doi.org/10.1093/ehjci/jew155

TY - JOUR

T1 - Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis

AU - Weir-McCall, Jonathan R.

AU - Fitzgerald, Kerrie

AU - Papagiorcopulo, Carla J.

AU - Gandy, Stephen J.

AU - Lambert, Matthew

AU - Belch, Jill J. F.

AU - Cavin, Ian

AU - Littleford, Roberta

AU - Macfarlane, Jennifer A.

AU - Matthew, Shona Z.

AU - Nicholas, R. Stephen

AU - Struthers, Allan D.

AU - Sullivan, Frank M.

AU - Waugh, Shelley A.

AU - White, Richard D.

AU - Houston, J. Graeme

N1 - The study was funded by the Souter Charitable Foundation and the Chest, Heart and Stroke Scotland Charity. J.R.W.M. is supported by the Wellcome Trust through the Scottish Translational Medicine and Therapeutics Initiative (grant no. WT 085664) in the form of a clinical research fellowship.

PY - 2016/8/22

Y1 - 2016/8/22

N2 - Aims: Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI).Methods and Results: A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m(2), P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function.Conclusion: Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.

AB - Aims: Unrecognized myocardial infarctions (UMIs) have been described in 19-30% of the general population using late gadolinium enhancement (LGE) on cardiac magnetic resonance. However, these studies have focused on an unselected cohort including those with known cardiovascular disease (CVD). The aim of the current study was to ascertain the prevalence of UMIs in a non-high-risk population using magnetic resonance imaging (MRI).Methods and Results: A total of 5000 volunteers aged >40 years with no history of CVD and a 10-year risk of CVD of <20%, as assessed by the ATP-III risk score, were recruited to the Tayside Screening for Cardiac Events study. Those with a B-type natriuretic peptide (BNP) level greater than their gender-specific median were invited for a whole-body MR angiogram and cardiac MR including LGE assessment. LGE was classed as absent, UMI, or non-specific. A total of 1529 volunteers completed the imaging study; of these, 53 (3.6%) were excluded because of either missing data or inadequate LGE image quality. Ten of the remaining 1476 (0.67%) displayed LGE. Of these, three (0.2%) were consistent with UMI, whereas seven were non-specific occurring in the mid-myocardium (n = 4), epicardium (n = 1), or right ventricular insertion points (n = 2). Those with UMI had a significantly higher BNP [median 116 (range 31-133) vs. 22.6 (5-175) pg/mL, P = 0.015], lower ejection fraction [54.6 (36-62) vs. 68.9 (38-89)%, P = 0.007], and larger end-systolic volume [36.3 (27-61) vs. 21.7 (5-65) mL/m(2), P = 0.014]. Those with non-specific LGE had lower diastolic blood pressure [68 (54-70) vs. 72 (46-98) mmHg, P = 0.013] but no differences in their cardiac function.Conclusion: Despite previous reports describing high prevalence of UMI in older populations, in a predominantly middle-aged cohort, those who are of intermediate or low cardiovascular risk have a very low risk of having an unrecognized myocardial infarct.

KW - Myocardial infarction

KW - Whole-body MRI

KW - Cardiac magnetic resonance

KW - Atherosclerosis

U2 - 10.1093/ehjci/jew155

DO - 10.1093/ehjci/jew155

M3 - Article

C2 - 27550660

SN - 2047-2404

JO - European Heart Journal - Cardiovascular Imaging

JF - European Heart Journal - Cardiovascular Imaging

ER -

Prevalence of unrecognized myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis

Abstract

Keywords

UN SDGs

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