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

Jonathan Weir-McCall, Carla J. Papagiorcopulo, Kerrie Fitzgerald, Stephen Gandy, Matthew Lambert, Jill Belch, Ian Cavin, Roberta Littleford, Jennifer A. MacFarlance, Shona Matthew, R. Stephen Nicholas, Allan Struthers, Frank Sullivan, Shelley A. Waugh, Richard D. White, John Houston (Lead / Corresponding author)

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Abstract

Unrecognised myocardial infarcts (UMIs) have been described in 19-44% of the general population, with prevalence increasing by 10% per decade and their presence associated with a similar or worse prognosis than recognised myocardial infarcts (RMIs).(1,2) The majority of population-based studies have focused on the use of ECG for the detection of UMI, however not all infarcts result in pathological Q waves.(3) Late gadolinium enhancement on cardiac magnetic resonance imaging (CMR) has become the clinical
gold standard for the detection of myocardial scarring, with a significantly higher detection rate of UMIs than using ECG alone.(4) These UMIs detected on CMR have significant clinical implications, with those with evidence of myocardial scarring in the absence of clinically-apparent prior infarct more likely to have chest pain, poorer left ventricular (LV) function, and suffer from a greater number of major adverse cardiovascular events.(4,5) Earlier studies have described the prevalence of UMIs in elderly populations at high risk of cardiovascular disease. These studies, by including those with known cardiovascular disease (CVD), have thereby conflated the prevalence of UMIs in the general population.(4,6) The prevalence of UMIs in a population without prior cardiovascular events and who are not at high risk has not been previously undertaken. Furthermore, a prior study of 75-years-olds has suggested that UMIs may not be associated with traditional CVD risk factors.(7) Thus identification of a cohort considered as low or intermediate risk that have suffered from UMIs may provide insight into novel predisposing aetiological factors. The aim of this study was to investigate the prevalence of UMIs in a large, non-high risk, asymptomatic cohort, assessed with magnetic resonance imaging (MRI), and the association between UMIs and risk markers for CVD.
Original languageEnglish
Pages (from-to)657-662
Number of pages6
JournalEuropean Heart Journal - Cardiovascular Imaging
Volume18
Issue number6
Early online date22 Aug 2016
DOIs
Publication statusPublished - Jun 2017

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Atherosclerosis
Myocardial Infarction
Cardiovascular Diseases
Magnetic Resonance Imaging
Population
Cicatrix
Electrocardiography
Gadolinium
Chest Pain
Left Ventricular Function
Causality

Keywords

  • myocardial infarction
  • whole-body MRI
  • cardiac magnetic resonance
  • atherosclerosis

Cite this

Weir-McCall, Jonathan ; Papagiorcopulo, Carla J. ; Fitzgerald, Kerrie ; Gandy, Stephen ; Lambert, Matthew ; Belch, Jill ; Cavin, Ian ; Littleford, Roberta ; MacFarlance, Jennifer A. ; Matthew, Shona ; Nicholas, R. Stephen ; Struthers, Allan ; Sullivan, Frank ; Waugh, Shelley A. ; White, Richard D. ; Houston, John. / Prevalence of unrecognised myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis. In: European Heart Journal - Cardiovascular Imaging. 2017 ; Vol. 18, No. 6. pp. 657-662.
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title = "Prevalence of unrecognised myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis",
abstract = "Unrecognised myocardial infarcts (UMIs) have been described in 19-44{\%} of the general population, with prevalence increasing by 10{\%} per decade and their presence associated with a similar or worse prognosis than recognised myocardial infarcts (RMIs).(1,2) The majority of population-based studies have focused on the use of ECG for the detection of UMI, however not all infarcts result in pathological Q waves.(3) Late gadolinium enhancement on cardiac magnetic resonance imaging (CMR) has become the clinicalgold standard for the detection of myocardial scarring, with a significantly higher detection rate of UMIs than using ECG alone.(4) These UMIs detected on CMR have significant clinical implications, with those with evidence of myocardial scarring in the absence of clinically-apparent prior infarct more likely to have chest pain, poorer left ventricular (LV) function, and suffer from a greater number of major adverse cardiovascular events.(4,5) Earlier studies have described the prevalence of UMIs in elderly populations at high risk of cardiovascular disease. These studies, by including those with known cardiovascular disease (CVD), have thereby conflated the prevalence of UMIs in the general population.(4,6) The prevalence of UMIs in a population without prior cardiovascular events and who are not at high risk has not been previously undertaken. Furthermore, a prior study of 75-years-olds has suggested that UMIs may not be associated with traditional CVD risk factors.(7) Thus identification of a cohort considered as low or intermediate risk that have suffered from UMIs may provide insight into novel predisposing aetiological factors. The aim of this study was to investigate the prevalence of UMIs in a large, non-high risk, asymptomatic cohort, assessed with magnetic resonance imaging (MRI), and the association between UMIs and risk markers for CVD.",
keywords = "myocardial infarction, whole-body MRI, cardiac magnetic resonance, atherosclerosis",
author = "Jonathan Weir-McCall and Papagiorcopulo, {Carla J.} and Kerrie Fitzgerald and Stephen Gandy and Matthew Lambert and Jill Belch and Ian Cavin and Roberta Littleford and MacFarlance, {Jennifer A.} and Shona Matthew and Nicholas, {R. Stephen} and Allan Struthers and Frank Sullivan and Waugh, {Shelley A.} and White, {Richard D.} and John Houston",
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.",
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Weir-McCall, J, Papagiorcopulo, CJ, Fitzgerald, K, Gandy, S, Lambert, M, Belch, J, Cavin, I, Littleford, R, MacFarlance, JA, Matthew, S, Nicholas, RS, Struthers, A, Sullivan, F, Waugh, SA, White, RD & Houston, J 2017, 'Prevalence of unrecognised myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis', European Heart Journal - Cardiovascular Imaging, vol. 18, no. 6, pp. 657-662. https://doi.org/10.1093/ehjci/jew155

Prevalence of unrecognised myocardial infarction in a low-intermediate risk asymptomatic cohort and its relation to systemic atherosclerosis. / Weir-McCall, Jonathan; Papagiorcopulo, Carla J.; Fitzgerald, Kerrie; Gandy, Stephen; Lambert, Matthew; Belch, Jill; Cavin, Ian; Littleford, Roberta; MacFarlance, Jennifer A.; Matthew, Shona; Nicholas, R. Stephen; Struthers, Allan; Sullivan, Frank; Waugh, Shelley A.; White, Richard D.; Houston, John (Lead / Corresponding author).

In: European Heart Journal - Cardiovascular Imaging, Vol. 18, No. 6, 06.2017, p. 657-662.

Research output: Contribution to journalArticle

TY - JOUR

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

AU - Weir-McCall, Jonathan

AU - Papagiorcopulo, Carla J.

AU - Fitzgerald, Kerrie

AU - Gandy, Stephen

AU - Lambert, Matthew

AU - Belch, Jill

AU - Cavin, Ian

AU - Littleford, Roberta

AU - MacFarlance, Jennifer A.

AU - Matthew, Shona

AU - Nicholas, R. Stephen

AU - Struthers, Allan

AU - Sullivan, Frank

AU - Waugh, Shelley A.

AU - White, Richard D.

AU - Houston, John

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 - 2017/6

Y1 - 2017/6

N2 - Unrecognised myocardial infarcts (UMIs) have been described in 19-44% of the general population, with prevalence increasing by 10% per decade and their presence associated with a similar or worse prognosis than recognised myocardial infarcts (RMIs).(1,2) The majority of population-based studies have focused on the use of ECG for the detection of UMI, however not all infarcts result in pathological Q waves.(3) Late gadolinium enhancement on cardiac magnetic resonance imaging (CMR) has become the clinicalgold standard for the detection of myocardial scarring, with a significantly higher detection rate of UMIs than using ECG alone.(4) These UMIs detected on CMR have significant clinical implications, with those with evidence of myocardial scarring in the absence of clinically-apparent prior infarct more likely to have chest pain, poorer left ventricular (LV) function, and suffer from a greater number of major adverse cardiovascular events.(4,5) Earlier studies have described the prevalence of UMIs in elderly populations at high risk of cardiovascular disease. These studies, by including those with known cardiovascular disease (CVD), have thereby conflated the prevalence of UMIs in the general population.(4,6) The prevalence of UMIs in a population without prior cardiovascular events and who are not at high risk has not been previously undertaken. Furthermore, a prior study of 75-years-olds has suggested that UMIs may not be associated with traditional CVD risk factors.(7) Thus identification of a cohort considered as low or intermediate risk that have suffered from UMIs may provide insight into novel predisposing aetiological factors. The aim of this study was to investigate the prevalence of UMIs in a large, non-high risk, asymptomatic cohort, assessed with magnetic resonance imaging (MRI), and the association between UMIs and risk markers for CVD.

AB - Unrecognised myocardial infarcts (UMIs) have been described in 19-44% of the general population, with prevalence increasing by 10% per decade and their presence associated with a similar or worse prognosis than recognised myocardial infarcts (RMIs).(1,2) The majority of population-based studies have focused on the use of ECG for the detection of UMI, however not all infarcts result in pathological Q waves.(3) Late gadolinium enhancement on cardiac magnetic resonance imaging (CMR) has become the clinicalgold standard for the detection of myocardial scarring, with a significantly higher detection rate of UMIs than using ECG alone.(4) These UMIs detected on CMR have significant clinical implications, with those with evidence of myocardial scarring in the absence of clinically-apparent prior infarct more likely to have chest pain, poorer left ventricular (LV) function, and suffer from a greater number of major adverse cardiovascular events.(4,5) Earlier studies have described the prevalence of UMIs in elderly populations at high risk of cardiovascular disease. These studies, by including those with known cardiovascular disease (CVD), have thereby conflated the prevalence of UMIs in the general population.(4,6) The prevalence of UMIs in a population without prior cardiovascular events and who are not at high risk has not been previously undertaken. Furthermore, a prior study of 75-years-olds has suggested that UMIs may not be associated with traditional CVD risk factors.(7) Thus identification of a cohort considered as low or intermediate risk that have suffered from UMIs may provide insight into novel predisposing aetiological factors. The aim of this study was to investigate the prevalence of UMIs in a large, non-high risk, asymptomatic cohort, assessed with magnetic resonance imaging (MRI), and the association between UMIs and risk markers for CVD.

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

VL - 18

SP - 657

EP - 662

JO - European Heart Journal - Cardiovascular Imaging

JF - European Heart Journal - Cardiovascular Imaging

SN - 2047-2404

IS - 6

ER -