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Related Experiment Video

Updated: Jun 21, 2025

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Cardiovascular Magnetic Resonance Before Invasive Coronary Angiography in Suspected Non-ST-Segment Elevation

Mayooran Shanmuganathan1, Chrysovalantou Nikolaidou2, Matthew K Burrage3

  • 1Acute Vascular Imaging Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, National Institute for Health and Care Research Oxford Biomedical Research Centre, Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, United Kingdom; Oxford University Hospitals National Health Service Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.

JACC. Cardiovascular Imaging
|July 6, 2024
PubMed
Summary

Cardiac magnetic resonance (CMR) effectively diagnoses myocardial infarction (MI) in suspected non-ST-segment elevation MI (NSTEMI) cases. This imaging strategy reclassifies diagnoses for over 50% of patients, guiding appropriate management.

Keywords:
CMRMINOCANSTEMIacute coronary syndromeearly cardiac magnetic resonancemyocarditis

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Medicine

Background:

  • Suspected non-ST-segment elevation myocardial infarction (NSTEMI) diagnoses are often uncertain, especially with nonobstructive coronary arteries (NOCA) or when the infarct-related artery is misidentified.
  • Accurate diagnosis is crucial for appropriate patient management and treatment strategies.

Purpose of the Study:

  • To evaluate the diagnostic value of cardiac magnetic resonance (CMR) in patients with suspected NSTEMI before invasive coronary angiography (ICA).
  • To determine if CMR can accurately identify myocardial infarction (MI) and differentiate it from other cardiac pathologies.

Main Methods:

  • 100 stable patients with suspected NSTEMI underwent pre-ICA CMR, including cine, T2-weighted imaging, T1 mapping, and late gadolinium enhancement.
  • CMR interpretation was blinded to ICA findings, and clinical teams were blinded to CMR results until post-ICA.

Main Results:

  • CMR confirmed MI in 67% of patients (52% subendocardial, 15% transmural).
  • Nonischemic pathologies (e.g., myocarditis, takotsubo) were identified in 18%, and 11% had normal CMR findings.
  • In patients with NOCA, CMR reclassified the diagnosis in 67%, identifying nonischemic causes or normal findings in most.

Conclusions:

  • A CMR-first approach in suspected NSTEMI identifies MI in 67% of cases.
  • CMR significantly impacts patient management by reclassifying diagnoses in at least 50% of individuals.
  • CMR aids in differentiating ischemic from non-ischemic cardiac conditions and can identify the correct infarct-related artery.