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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI
1Department of Cardiology, Southampton University Hospitals NHS Trust, Southampton, UK.
Insights
Cardiac MRI with late gadolinium enhancement (LGE-CMRI) effectively diagnoses causes of troponin-positive chest pain in patients with clear coronary arteries. This imaging tool aids in accurate non-ST-segment elevation myocardial infarction (NSTEMI) diagnosis and management.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Medicine
Background:
- Chest pain with elevated troponin but clear coronary arteries presents a diagnostic challenge.
- Accurate diagnosis is crucial to avoid implications of misdiagnosed non-ST-segment elevation myocardial infarction (NSTEMI).
Purpose of the Study:
- To evaluate the utility of cardiac MRI (CMRI) with late gadolinium enhancement (LGE) in diagnosing cardiac conditions.
- To assess the diagnostic yield of LGE-CMRI in patients presenting with troponin-positive chest pain and unobstructed coronary arteries.
Main Methods:
- A cohort of 91 patients with cardiac chest pain, elevated troponin I, and unobstructed coronary arteries underwent outpatient CMRI with LGE.
- Coronary angiography was performed during the index admission.
Main Results:
- 73% of patients showed no abnormalities on LGE-CMRI.
- 16% exhibited findings consistent with myocarditis (patchy late enhancement).
- 11% demonstrated myocardial infarction (focal subendocardial or full thickness late enhancement).
- No deaths occurred during a mean follow-up of 21 months.
Conclusions:
- LGE-CMRI is valuable for definitive diagnosis in patients with troponin-positive chest pain and unobstructed coronary arteries.
- It aids in distinguishing between myocarditis, myocardial infarction, and normal findings.
- Accurate diagnosis impacts long-term management strategies, avoiding consequences of misdiagnosed NSTEMI.
Objective:
The purpose of this study was to assess the outcome of cardiac MRI (CMRI) with late gadolinium enhancement (LGE) at outpatient follow-up in a consecutive series of patients with troponin-positive chest pain but unobstructed coronary arteries at the index admission.
Methods:
The study group comprised 91 consecutive patients who presented to our institution with cardiac chest pain, elevated troponin I and unobstructed coronary arteries on coronary angiography. All patients underwent an outpatient CMRI with LGE imaging in order to establish a definitive diagnosis.
Results:
The average time from coronary angiography to LGE-CMRI was 2 months. 73% of patients had no abnormality on their LGE-CMRI, 16% of patients had patchy late enhancement consistent with myocarditis and 11% had focal subendocardial or full thickness late enhancement consistent with myocardial infarction. There were no deaths in this cohort during a mean follow-up of 21 months.
Conclusion:
LGE-CMRI is a useful tool for establishing whether such patients have definitive evidence of non-ST-segment elevation myocardial infarction (NSTEMI), and can make an important contribution to the long-term management strategy of these patients as an inappropriate diagnosis of NSTEMI carries important medical, social and financial implications.
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