Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries:...

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a complex condition with diverse causes, leading to significant patient morbidity and mortality.
• Current guidelines recommend a multimodality imaging approach for diagnosing MINOCA, a condition often treated as a working diagnosis.

Purpose of the Study:

• To review current guidelines and consensus statements for MINOCA evaluation.
• To discuss contemporary multimodality imaging techniques in MINOCA diagnosis and prognostication.
• To explore emerging treatment strategies for MINOCA, including ongoing clinical trials.

Main Methods:

• Review of recent society guidelines and consensus statements on MINOCA evaluation.
• Analysis of contemporary multimodality imaging approaches, including cardiac magnetic resonance (CMR) and invasive coronary imaging (intravascular ultrasound, optical coherence tomography).
• Discussion of the role of noninvasive imaging, such as coronary computed tomography angiography, in MINOCA diagnosis and follow-up.

Main Results:

• Cardiac MRI is effective in excluding nonischemic mimics like myocarditis and Takotsubo cardiomyopathy, aiding long-term prognostication.
• Invasive coronary imaging can identify plaque composition, disruption, or spontaneous coronary dissection.
• Multimodality imaging, particularly CMR combined with invasive techniques, can establish a diagnosis in most MINOCA patients.

Conclusions:

• While diagnostic strategies for MINOCA have advanced, significant knowledge gaps persist, especially concerning treatment.
• Multimodality imaging plays a crucial role in diagnosing MINOCA and guiding patient management.
• Further research into effective treatment strategies is essential for improving outcomes in MINOCA patients.