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Cardiac magnetic resonance in patients with elevated troponin and normal coronary angiography

Subir Bhatia1, Christopher Anstine1, Allan S Jaffe2

  • 1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Heart (British Cardiac Society)
|April 6, 2019
PubMed

Insights

Cardiac Magnetic Resonance (CMR) helps diagnose heart conditions when troponin is elevated but coronary angiography is negative. Small area myocardial infarction was found in 22% of patients, highlighting CMR's diagnostic value.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Diagnostic Medicine

Background:

  • Elevated cardiac troponin with non-obstructive coronary arteries creates diagnostic uncertainty.
  • Cardiac Magnetic Resonance (CMR) may offer diagnostic clarity in such cases.
  • The full spectrum of CMR findings in this specific patient group remains incompletely described.

Purpose of the Study:

  • To describe the spectrum of cardiac diagnoses identified by CMR.
  • To evaluate the utility of CMR in patients with elevated troponin and non-obstructive coronary arteries.

Main Methods:

  • Retrospective analysis of inpatient records (2000-2016) at Mayo Clinic, Rochester.
  • Inclusion criteria: elevated troponin T, negative coronary angiography, and CMR within 30 days.
  • CMR diagnoses were categorized into myocarditis, small area myocardial infarction, stress cardiomyopathy, non-ischaemic cardiomyopathy, or normal.

Main Results:

  • Myocarditis was the most common diagnosis (32%).
  • Small area myocardial infarction was identified in 22% of patients.
  • Non-ischaemic cardiomyopathy (20%) and stress cardiomyopathy (9.3%) were also observed.

Conclusions:

  • This study provides the largest single-center assessment of CMR in patients with elevated troponin and non-obstructive coronary disease.
  • Small area myocardial infarction is a significant finding in 22% of these patients.
  • CMR is valuable for diagnosing various cardiac conditions in the setting of elevated troponin and non-obstructive coronary arteries.
Abstract

Keywords:
acute myocardial infarctioncardiac magnetic resonance (cmr) imaging

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