No block, still shock: the role of strain echocardiography in MINOCA evaluation

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) presents a diagnostic and therapeutic challenge, as patients exhibit clinical features of myocardial infarction (MI) without significant coronary obstruction on angiography. Strain echocardiography, specifically left ventricular global longitudinal strain (LV-GLS), may provide added value in detecting subclinical myocardial dysfunction in this population. Purpose To evaluate the clinical characteristics of patients with MINOCA and assess the diagnostic and prognostic utility of strain echocardiography. Methods A total of 287 patients presenting with acute coronary syndrome (ACS) and undergoing coronary angiography between January and June 2024 were included. Patients were categorized into three groups based on angiographic findings: MI with obstructive coronary arteries (MIOCA; ≥50% stenosis, n=237), MINOCA (