Abstract Aims To report the extent and distribution of myocardial injury and its impact on left ventricular systolic function with cardiac magnetic resonance imaging (CMR) following spontaneous coronary artery dissection (SCAD) and to investigate predictors of myocardial injury. Methods and results One hundred and fifty-eight angiographically confirmed SCAD-survivors (98% female) were phenotyped by CMR and compared in a case–control study with 59 (97% female) healthy controls (44.5 ± 8.4 vs. 45.0 ± 9.1 years). Spontaneous coronary artery dissection presentation was with non-ST-elevation myocardial infarction in 95 (60.3%), ST-elevation myocardial infarction (STEMI) in 52 (32.7%), and cardiac arrest in 11 (6.9%). Left ventricular function in SCAD-survivors was generally well preserved with small reductions in ejection fraction (57 ± 7.2% vs. 60 ± 4.9%, P < 0.01) and increases in left ventricular dimensions (end-diastolic volume: 85 ± 14 mL/m2 vs. 80 ± 11 mL/m2, P < 0.05; end-systolic volume: 37 ± 11 mL/m2 vs. 32 ± 7 mL/m2, P <0.01) compared to healthy controls. Infarcts were small with few large infarcts (median 4.06%; range 0–30.9%) and 39% having no detectable late gadolinium enhancement (LGE). Female SCAD patients presenting with STEMI had similar sized infarcts to female Type-1 STEMI patients age <75 years. Multivariate modelling demonstrated STEMI at presentation, initial TIMI 0/1 flow, multivessel SCAD, and a Beighton score >4 were associated with larger infarcts [>10% left ventricular (LV) mass]. Conclusion The majority of patients presenting with SCAD have no or small infarctions and preserved ejection fraction. Patients presenting with STEMI, TIMI 0/1 flow, multivessel SCAD and those with features of connective tissue disorders are more likely to have larger infarcts.

中文翻译：

---

自发性冠状动脉夹层后慢性梗死面积：对病理生理学和临床管理的影响

摘要 目的通过自发性冠状动脉夹层（SCAD）后心脏磁共振成像（CMR）报告心肌损伤的范围和分布及其对左心室收缩功能的影响，并研究心肌损伤的预测因素。方法和结果 158 名经血管造影证实的 SCAD 幸存者（98% 女性）通过 CMR 进行表型分析，并在病例对照研究中与 59 名（97% 女性）健康对照（44.5 ± 8.4 岁与 45.0 ± 9.1 岁）进行比较）。自发性冠状动脉夹层表现为非 ST 段抬高心肌梗死 95 例（60.3%），ST 段抬高心肌梗死（STEMI）52 例（32.7%），心脏骤停 11 例（6.9%）。SCAD 幸存者的左心室功能通常保存良好，射血分数略有下降（57 ± 7.2% 与 60 ± 4%。9%，P < 0.01）和左心室尺寸增加（舒张末期容积：85 ± 14 mL/m2 与 80 ± 11 mL/m2，P < 0.05；收缩末期容积：37 ± 11 mL/m2 与. 32 ± 7 mL/m2, P <0.01) 与健康对照相比。梗塞很小，很少有大梗塞（中位数为 4.06%；范围为 0-30.9%），39% 没有可检测到的晚期钆增强 (LGE)。出现 STEMI 的女性 SCAD 患者与年龄 <75 岁的女性 1 型 STEMI 患者具有相似大小的梗塞。多变量模型显示，就诊时出现 STEMI、初始 TIMI 0/1 血流、多支血管 SCAD 和 Beighton 评分 >4 与较大的梗死 [>10% 左心室 (LV) 质量] 相关。结论 大多数 SCAD 患者没有或仅有少量梗塞，射血分数保持不变。出现 STEMI、TIMI 0/1 血流的患者，