Cardiac magnetic resonance imaging in patients with chest pain, high troponin levels and absence of coronary artery obstruction

Gustavo P. Avegliano, Marina Huguet, Juan P. Costabel, Paola Kuschnir, Jorge Thierer, Alberto Alves de Lima, Gustavo Sanchez, Mario Petit, Alejandro F Frangi, Ricardo Ronderos

Research output: Contribution to journalArticlepeer-review

Abstract

The prevalence of myocardial infarction with angiographically normal coronary arteries is approximately 7-10%. The etiological diagnosis is sometimes difficult and is important in terms of clinical practice and prognosis. The goal of our study was to show a series of consecutive patients with an initial diagnosis of acute coronary syndrome with high troponin levels and absence of coronary artery obstruction in which cardiac magnetic resonance imaging (CMRI) gave a description of the myocardial lesion, orientating towards the etiological diagnosis. From January 2005 to December 2009, 720 consecutive patients with an initial diagnosis of acute coronary syndrome and elevated troponins were included; 64 of these patients did not present angiographically significant coronary artery stenosis. Within 72 ± 24 h after coronary angiography, these patients underwent CMRI using b-SSFP sequences for cine imaging in short-axis, 2-, 3- and 4- chamber views for the evaluation of segmental wall motion, with T2-weighted and delayed enhancement (DE) images of the myocardium with an "inversion-recovery" sequence. The following diagnoses were made: myocarditis (39 patients); myocardial infarction (12 patients); Tako-Tsubo syndrome (8 patients); apical hypertrophic cardiomyopathy (2 patients); 3 patients remained without diagnosis. These findings demonstrate the usefulness of CMRI in the clinical scenario of patients with chest pain, inconclusive ECG findings and high troponin levels with angiographically normal coronary arteries. The presence and distribution pattern of DE make it possible to define the etiological diagnosis and interpret the physiopathological process.

Original languageEnglish
Pages (from-to)226-230
Number of pages5
JournalRevista Argentina de Cardiologia
Volume79
Issue number3
Publication statusPublished - 2011

Keywords

  • Infarction
  • Magnetic resonance spectroscopy
  • Myocarditis

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