CMR-Derived ECV Predicts Long-Term Risk of MACE in 'True' MINOCA Patients: Study

The study, led by Lei Chen and colleagues from the Department of Cardiology at Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China, was published in the International Journal of Cardiology. The findings provide important insights into the prognostic role of ECV in MINOCA and offer new opportunities to improve risk stratification and management of these patients.

MINOCA represents a complex clinical entity often leading to diagnostic uncertainty and undertreatment. Patients with this condition face considerable risks of adverse outcomes, including mortality and reduced quality of life, underscoring the need for improved diagnostic and prognostic strategies. While cardiac magnetic resonance (CMR) imaging is endorsed by both the American Heart Association (AHA) and the European Society of Cardiology (ESC) guidelines as a key tool in MINOCA evaluation, the role of CMR-derived ECV in predicting outcomes has remained poorly defined.

To address this gap, the study examined ECV distribution across various MINOCA subtypes and assessed its predictive value for long-term outcomes. The researchers analyzed data from 275 consecutive patients with a working diagnosis of MINOCA who underwent CMR within a median of four days from presentation. Among these, 96 patients were classified as having "true" MINOCA based on evidence of myocardial ischemia or infarction on imaging. Other diagnoses included myocarditis (66 patients), Takotsubo syndrome (31 patients), cardiomyopathies (34 patients), and normal findings (48 patients).

The key findings were as follows:

• Patients with "true" MINOCA had significantly higher ECV levels compared to other diagnoses (29.1% vs. 26.0%).
• During a median follow-up of 26.6 months, 29.2% of "true" MINOCA patients experienced major adverse cardiovascular events (MACE).
• Elevated ECV was found to be an independent predictor of MACE (hazard ratio 1.063).
• Patients with ECV values greater than 28.94% had a significantly higher risk of experiencing adverse events.
• There was a dose-response relationship between ECV levels and MACE risk indicating that CMR-derived ECV could be a useful marker for clinical risk stratification in "true" MINOCA patients.

The authors concluded, "These findings highlight the potential utility of CMR-derived ECV in identifying MINOCA patients at greater risk for adverse outcomes and emphasize the need for closer follow-up and tailored management strategies for this vulnerable population."

Reference:

Chen, L., Ge, L., Abdu, F. A., Du, X., Liu, J., Chen, W., Lu, Y., & Che, W. (2025). Prognostic value of CMR-derived extracellular volume in myocardial infarction with non-obstructive coronary arteries. International Journal of Cardiology, 133528. https://doi.org/10.1016/j.ijcard.2025.133528