Prevalence and Prognosis of Unrecognized Myocardial Infarction Determined by Cardiac Magnetic Resonance in Older Adults

Schelbert, Erik B.; Cao, Jie J; Sigurðsson, Sigurður; Aspelund, Thor; Kellman, Peter; Aletras, Anthony H.; Dyke, Christopher K.; Þorgeirsson, Guðmundur; Eiríksdóttir, Guðný; Launer, Lenore J.; Gudnason, Vilmundur; Harris, Tamara B.; Arai, Andrew E.

doi:10.1001/2012.jama.11089

Cited by 252 publications

(252 citation statements)

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“…The sample size for this cohort has been previously described (n=936) 16. Recruitment occurred in 2 phases.…”

Section: Methodsmentioning

confidence: 99%

“…All CMR studies were performed on a 1.5‐T Signa Twinspeed scanner using a 4‐element cardiac phased–array coil (General Electric Medical Systems, Waukesha, WI) as previously described 16, 25. Images were acquired during breath‐hold and triggered to the ECG or to pulse oximetry if ECG gating was suboptimal.…”

Section: Methodsmentioning

confidence: 99%

“…Imaging was performed to evaluate MI scar, typically 6 to 15 minutes after injection of gadopentetate dimeglumine at low dose (0.1 mmol/kg; Magnevist, Schering AG, Berlin, Germany), using a phase‐sensitive segmentation gradient echo inversion recovery sequence 25. Calculated median glomerular filtration rate was 69 (interquartile range 59–82) mL/min per 1.73 m 2 and no subject had significant renal failure 16, 30…”

Section: Methodsmentioning

confidence: 99%

“…The analytic sample consisted of 936 subjects described previously who completed the CMR examination on average 31 (3) years after the baseline Reykjavik visit 16. There were 1 or more assessments of risk factors in the subjects at midlife; 460 had 1 assessment, 185 had 2 assessments, 42 had 3 assessments, 93 had 4 assessments, and 156 had 5 assessments between 1967 and 1991.…”

Section: Methodsmentioning

confidence: 99%

“…Indeed, CMR is the most accurate method available to detect myocardial scar and reports a higher prevalence of UMI16, 17, 21 than other technologies, making it more precise for population‐based studies 22. The association of UMI detected by CMR with specific risk factors measured decades earlier has not been reported previously.…”

Section: Introductionmentioning

confidence: 99%

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Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

McAreavey

Vidal

Aspelund

et al. 2016

JAHA

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BackgroundAssociations of atherosclerosis risk factors with unrecognized myocardial infarction (UMI) are unclear. We investigated associations of midlife risk factors with UMI and recognized MI (RMI) detected 31 years later by cardiac magnetic resonance.Methods and ResultsThe Reykjavik Study (1967–1991) collected serial risk factors in subjects, mean (SD) age 48 (7) years. In ICELAND‐MI (2004–2007), 936 survivors (76 (5) years) were evaluated by cardiac magnetic resonance. Analysis included logistic regression and random effects modeling. Comparisons are relative to subjects without MI. At baseline midlife evaluation, a modified Framingham risk score was significantly higher in RMI and in UMI versus no MI (7.4 (6.3)%; 7.1 (6.2)% versus 5.4 (5.8)%, P<0.001). RMI and UMI were more frequent in men (65%, 64% versus 43%; P<0.0001). Baseline systolic and diastolic blood pressure were significantly higher in UMI (138 (17) mm Hg versus 133 (17) mm Hg; P<0.006; 87 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Diastolic BP was significantly higher in RMI (88 (10) mm Hg versus 84 (10) mm Hg; P<0.02). Cholesterol and triglycerides were significantly higher in RMI (6.7 (1.1) mmol/L versus 6.2 (1.1) mmol/L; P=0.0005; and 1.4 (0.7) mmol/L versus 1.1 (0.7) mmol/L; P<0.003). Cholesterol trended higher in UMI (P=0.08). Serial midlife systolic BP was significantly higher in UMI versus no MI (β [SE] = 2.69 [1.28] mm Hg, P=0.04). Serial systolic and diastolic BP were significantly higher in RMI versus no MI (4.12 [1.60] mm Hg, P=0.01 and 2.05 [0.91] mm Hg, P=0.03) as were cholesterol (0.43 [0.11] mmol/L, P=0.0001) and triglycerides (0.3 [0.06] mmol/L, P<0.0001).ConclusionsMidlife vascular risk factors are associated with UMI and RMI detected by cardiac magnetic resonance 31 years later. Systolic blood pressure was the most significant modifiable risk factor associated with later UMI.

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“…The sample size for this cohort has been previously described (n=936) 16. Recruitment occurred in 2 phases.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

McAreavey

Vidal

Aspelund

et al. 2016

JAHA

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Cardiovascular Imaging in Clinical Practice

Gupta¹,

Kwong²,

Pfeffer³

2013

JAMA

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Prevalence and Correlates of Myocardial Scar in a US Cohort

Türkbey

Nacif

Guo

et al. 2015

JAMA

120

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Importance Myocardial scarring leads to cardiac dysfunction and poor prognosis. The prevalence of and factors associated with unrecognized myocardial infarction and scar have not been previously defined using current methods in a multi-ethnic US population. Objective To determine prevalence of and factors associated with myocardial scar in middle and older aged individuals in the United States (U.S). Design, Setting, and Participants Multi-Ethnic Study of Atherosclerosis (MESA) is a population based cohort in the U.S. MESA participants were 45-84 years old and free of clinical cardiovascular disease (CVD) at baseline in 2000-2002. In the 10th year examination of MESA (2010-2012), 1840 participants underwent cardiac magnetic resonance imaging (CMR) with gadolinium to detect myocardial scar. CVD risk factors and coronary artery calcium scores were measured at baseline and year 10. Logistic regression models were used to estimate adjusted odds ratios for myocardial scar. Exposures Cardiovascular risk factors, coronary artery calcium, left ventricle size and function, carotid intima media thickness Main Outcome Measure Myocardial scar detected by CMR. Results Of 1840 participants (mean age 68±9 yrs, 52% male), 146 had myocardial scars (7.9%). Most myocardial scars (114/146, 78%) were undetected by electrocardiogram or by clinical adjudication. In adjusted models, age, male gender, body mass index, hypertension, and current smoking at baseline were associated with myocardial scar at year 10 [OR (95% CI): 1.6 (1.4, 1.9) per 8.9 years, p<0.001; 5.8 (3.6, 9.2) men vs. women, p<0.001; 1.3 (1.1, 1.6) per 4.8 kg/m2, p=0.005, 1.6 (1.1, 2.3) for hypertension present, p=0.009; 2.0 (1.2, 3.3) current vs. never smokers, p=0.006, respectively]. Age, gender and ethnicity adjusted CAC score at baseline was also associated with myocardial scar at year 10 [CAC categories of 1-99, 100-399 and ≥ 400 vs. CAC =0: OR (95% CI): 2.4 (1.5, 3.9), 3.0 (1.7, 5.1), 3.3 (1.7, 6.1), respectively, p≤0.001]. CAC score significantly added to the association of myocardial scar with age, gender, ethnicity and traditional CVD risk factors (c-statistic: 0.81 vs. 0.79, with vs. without CAC, respectively, p=0.012). Conclusions and Relevance The prevalence of myocardial scars in a US community based multiethnic cohort was 7.9%, of which 78% were unrecognized by electrocardiography or clinical evaluation. Further studies are needed to understand the clinical consequences of these undetected scars and the utility of their identification.

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Prevalence and Prognosis of Unrecognized Myocardial Infarction Determined by Cardiac Magnetic Resonance in Older Adults

Cited by 252 publications

References 29 publications

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

Cardiovascular Imaging in Clinical Practice

Prevalence and Correlates of Myocardial Scar in a US Cohort

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