Infarction, Myocardial, Myocardial Injury, Myocarditis; Acute or Subacute, Takotsubo Cardiomyopathy
Conditions
Brief summary
Clinical management of patients with chest pain and elevation of biomarkers of myocardial injury require an accurate diagnosis. Until now, cardiac magnetic resonance imaging (cMRI) is the gold standard for the diagnosis among myocarditis, stress cardiomyopathy, or inapparent ischemic damage. The development of spectral CT has opened up the possibility of characterizing the coronary anatomy and the myocardium in a single procedure. Our aim is to assess the diagnostic ability of differential patterns in first- pass perfusion and delayed iodine enhancement obtained by spectral CT in patients with acute myocardial injury. This study is designed as a prospective multicenter observational study with diagnostic intervention in 150 patients admitted with clinical indication of a cMRI due to suspicion of myocardial infarction with normal coronary arteries (MINOCA), myocarditis or stress cardiomyopathy who will undergo a CT study with double detector technology in two reference centers. A control group (n=150) with an indication for cardiac CT for another cause without coronary or structural heart disease will be included. The iodine maps obtained by spectral CT will be compared with the findings obtained with cMRI, both with conventional techniques and with artificial intelligence algorithms (deep learning). A year follow-up of the cohort will be carried out to assess whether the findings derived from the CT in this group of patients provide prognostic information
Interventions
DIAGNOSTIC_TESTSpectral CT
Myocardial tissue characterization with Spectral CT
Sponsors
Hospital Universitario Ramon y Cajal
Salamanca University Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Age ≥ 18 year. * Hospital admission due to chest pain and acute myocardial injury. * Clinical indication for cardiac MRI (CMR) due to suspected acute myocardial infarction with coronary angiography showing no significant lesions (\<50%) (MINOCA), acute myocarditis, or stress-induced cardiomyopathy. * Signed informed consent.
Exclusion criteria
* Contraindications to undergo cardiac MRI and CT with administration of gadolinium and/or iodine-based contrast, respectively. * Pre-existing cardiomyopathy. * Pre-existing chronic ischemic heart disease. * Invasive coronary angiography showing coronary lesions ≥50%.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between volume of myocardium with abnormal perfusion (measured using spectral iodine density images) and percentage of myocardium with late gadolinium enhacement -LGE- (measured by CMR). | 2 years | To describe the differential alterations in first-pass and late iodine-enhanced images using spectral CT in patients diagnosed with MINOCA, myocarditis, and stress-induced cardiomyopathy, and comparing them with findings obtained by cardiac MRI. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Characterize acute myocardial injury using spectral images obtained after the administration of iodine-based contrast in patients with MINOCA, acute myocarditis, and stress-induced cardiomyopathy, as well as in control subjects. | 2 years | Characterize acute myocardial injury using spectral images obtained both in the early (first-pass) phase and in the late gadolinium-enhanced phase after the administration of iodine-based contrast in patients with MINOCA, acute myocarditis, and stress-induced cardiomyopathy, as well as in control subjects. |
| To describe the type of perfusion abnormality (hyperemia o perfusion deficit) which correlates with ischaemic and inflammatory,no ischemic myocardial injuries. | 2 years | Assess whether spectral CT allows differentiation between the different etiologies of myocardial injury. |
Countries
Spain
Contacts
Primary ContactCandelas Perez-Del Villar, MD, PhD
Outcome results
None listed