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Characterization of patients with acute chest pain using cardiac magnetic resonance imaging

Vinzenz Hombach1, Nico Merkle, Hans A Kestler

  • 1Department of Internal Medicine II, University of Ulm, Ulm, Germany. vinzenz.hombach@uniklinik-ulm.de

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|June 3, 2008
PubMed

Insights

Cardiac magnetic resonance imaging (CMRI) effectively differentiates causes of acute chest pain. CMRI reveals distinct patterns in ST-elevation myocardial infarction (STEMI), NSTEMI, myocarditis, and Tako-tsubo cardiomyopathy, aiding diagnosis.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Medicine

Background:

  • Acute chest pain is a common presentation requiring accurate diagnosis.
  • Differentiating between coronary and non-coronary causes of chest pain is crucial for appropriate management.
  • Cardiac magnetic resonance imaging (CMRI) is a non-invasive tool with potential for detailed cardiac assessment.

Purpose of the Study:

  • To assess the utility of CMRI in identifying characteristic findings in patients presenting with acute chest pain.
  • To differentiate between ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), acute myocarditis, and Tako-tsubo cardiomyopathy using CMRI.

Main Methods:

  • 230 patients with acute chest pain underwent cardiac catheterization and CMRI.
  • Patients were diagnosed with STEMI (n=102), NSTEMI (n=89), acute myocarditis (n=27), or Tako-tsubo cardiomyopathy (n=12).
  • CMRI assessed wall motion abnormalities, late enhancement (LE), microvascular obstruction, and ventricular volumes/function.

Main Results:

  • Ventricular volumes differed significantly across groups, highest in myocarditis.
  • Wall motion abnormalities were present in all STEMI and Tako-tsubo patients, 75% of NSTEMI, and 67% of myocarditis.
  • Characteristic LE patterns (subendocardial/transmural in STEMI/NSTEMI, diffuse in myocarditis, absent in Tako-tsubo) and microvascular obstruction (STEMI/NSTEMI) were observed.

Conclusions:

  • CMRI demonstrates distinct patterns of LE, microvascular obstruction, and wall motion abnormalities.
  • These characteristic findings enable differentiation of acute chest pain causes, distinguishing coronary from non-coronary origins.
Abstract

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