Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms

Med Sci Monit. 2015 Jan 14;21:171-80
Kawecki D, Morawiec B, Monney P, Pellaton C, Wojciechowska C, Jojko J, Basiak M, Przywara-Chowaniec B, Fournier S, Nowalany-Kozielska E, Schwitter J, Muller O.

Background In spite of robust knowledge about underlying ischemic myocardial damage, acute coronary syndromes (ACS) with culprit-free angiograms raise diagnostic concerns. The present study aimed to evaluate the additional value of cardiac magnetic resonance (CMR) over commonly available non-CMR standard tests, for the differentiation of myocardial injury in patients with ACS and non-obstructed coronary arteries. Material and Methods Patients with ACS, elevated hs-TnT, and a culprit-free angiogram were prospectively enrolled into the study between January 2009 and July 2013. After initial evaluation with standard tests (ECG, echocardiography, hs-TnT) and provisional exclusion of acute myocardial infarction (AMI) in coronary angiogram, patients were referred for CMR with the suspicion of myocarditis or Takotsubo cardiomyopathy (TTC). According to the result of CMR, patients were reclassified as having myocarditis, AMI, TTC, or non-injured myocardium as assessed by late gadolinium enhancement. Results Out of 5110 patients admitted with ACS, 75 had normal coronary angiograms and entered the study; 69 of them (92%) were suspected for myocarditis and 6 (8%) for TTC. After CMR, 49 patients were finally diagnosed with myocarditis (65%), 3 with TTC (4%), 7 with AMI (9%), and 16 (21%) with non-injured myocardium. The provisional diagnosis was changed or excluded in 23 patients (31%), with a 9% rate of unrecognized AMI. Conclusions The study results suggest that the evaluation of patients with ACS and culprit-free angiogram should be complemented by a CMR examination, if available, because the initial work-up with non-CMR tests leads to a significant proportion of misdiagnosed AMI.

References

  • Kawecki D1, Morawiec B1, Monney P2, Pellaton C3, Wojciechowska C1, Jojko J1, Basiak M4, Przywara-Chowaniec B1, Fournier S3, Nowalany-Kozielska E1, Schwitter J2, Muller O3. Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms. Med Sci Monit. 2015 Jan 14;21:171-80. PMID: 25604184.