Abstract
BackgroundTo investigate the association between unrecognized myocardial infarction (UMI) assessed with cardiac magnetic resonance (CMR) and coronary artery calcium (CAC) and cardiovascular risk prediction scores in asymptomatic Asian subjects.Materials and methodsTotal 872 asymptomatic subjects without prior cardiovascular event (male:female, 817:55; age, 53.88 ± 5.91) who underwent both CMR and CAC scoring CT were included. UMI were accessed and framingham risk score (FRS) and ASCVD (atherosclerotic cardiovascular disease) risk score by ACC/AHA were calculated.ResultsLate gadolinium enhancement indicating UMI was noted in 23 of 872 subjects (2.64%), but only three of them showed ECG abnormality (13.04%). Subjects with UMI showed higher CAC scores, FRS, and ASCVD scores than those without UMI (p < .001, p = .011 and p = .024, respectively). The prevalence of UMI differed significantly according to the CAC scores as follows: 1% in CAC = 0 (4/403), 1% in 1 ≤ CAC <100 (2/293), 6.1% in 100 ≤ CAC < 400 (7/114) and 14.5% in CAC ≥ 400 (9/62), respectively (p < .001). Receiver operating characteristics (ROC) analysis by using CAC score demonstrated an area under the curve (AUC) of 0.816 (95% confidence interval (CI), 0.780–0.848; p < .0001) for predicting UMI, which is superior to FRS [AUC, 0.712; 95% CI, 0.671–0.751; p = .009] and ASCVD risk score [AUC, 0.689; 95% CI, 0.648–0.729; p = .036].ConclusionThe prevalence of UMI increases with increasing burden of CAC and FRS. CAC score is a good discriminator for UMI, superior to FRS and ASCVD score, in asymptomatic population.
Highlights
Introduction of late gadolinium enhancement (LGE) images on cardiac magnetic resonance (CMR) allows accurate detection of myocardial infarctions (MIs) and other myocardial scars
CAC score is a good discriminator for unrecognized myocardial infarction (UMI), superior to framingham risk score (FRS) and ASCVD score, in asymptomatic population
Studies including patients with coronary artery disease (CAD) stated that the presence of UMI is an independent predictor of major adverse cardiac events (MACE) and cardiac mortality. [2,7,8] Several studies of elderly population showed that the presence of UMI entailed a risk for MACE.[9,10]
Summary
Introduction of late gadolinium enhancement (LGE) images on cardiac magnetic resonance (CMR) allows accurate detection of myocardial infarctions (MIs) and other myocardial scars. With advances of LGE imaging technique, the detection rate of clinically unrecognized MIs (UMIs) has increased. Various population studies have been performed in Sweden, Iceland, Scotland and US to document the prevalence and clinical impact of myocardial scars and UMIs.[1,3,4,5,6] Studies including patients with coronary artery disease (CAD) stated that the presence of UMI is an independent predictor of major adverse cardiac events (MACE) and cardiac mortality. To investigate the association between unrecognized myocardial infarction (UMI) assessed with cardiac magnetic resonance (CMR) and coronary artery calcium (CAC) and cardiovascular risk prediction scores in asymptomatic Asian subjects
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