14 January 2015 : Original article
Diagnostic Contribution of Cardiac Magnetic Resonance in Patients with Acute Coronary Syndrome and Culprit-Free Angiograms
Damian KaweckiABDEFG, Beata MorawiecCDEF, Pierre MonneyDEF, Cyril PellatonAB, Celina WojciechowskaB, Joanna JojkoB, Marcin BasiakBD, Brygida Przywara-ChowaniecBD, Stephane FournierBC, Ewa Nowalany-KozielskaEF, Juerg SchwitterDEFG, Olivier MullerDEFDOI: 10.12659/MSM.892296
Med Sci Monit 2015; 21:171-180
Abstract
BACKGROUND: In spite of robust knowledge about underlying ischemic myocardial damage, acute coronary syndromes (ACS) with culprit-free angiograms raise diagnostic concerns. The present study aimed to evaluate the additional value of cardiac magnetic resonance (CMR) over commonly available non-CMR standard tests, for the differentiation of myocardial injury in patients with ACS and non-obstructed coronary arteries.
MATERIAL AND METHODS: Patients with ACS, elevated hs-TnT, and a culprit-free angiogram were prospectively enrolled into the study between January 2009 and July 2013. After initial evaluation with standard tests (ECG, echocardiography, hs-TnT) and provisional exclusion of acute myocardial infarction (AMI) in coronary angiogram, patients were referred for CMR with the suspicion of myocarditis or Takotsubo cardiomyopathy (TTC). According to the result of CMR, patients were reclassified as having myocarditis, AMI, TTC, or non-injured myocardium as assessed by late gadolinium enhancement.
RESULTS: Out of 5110 patients admitted with ACS, 75 had normal coronary angiograms and entered the study; 69 of them (92%) were suspected for myocarditis and 6 (8%) for TTC. After CMR, 49 patients were finally diagnosed with myocarditis (65%), 3 with TTC (4%), 7 with AMI (9%), and 16 (21%) with non-injured myocardium. The provisional diagnosis was changed or excluded in 23 patients (31%), with a 9% rate of unrecognized AMI.
CONCLUSIONS: The study results suggest that the evaluation of patients with ACS and culprit-free angiogram should be complemented by a CMR examination, if available, because the initial work-up with non-CMR tests leads to a significant proportion of misdiagnosed AMI.
Keywords: Cardiology - methods, Acute Coronary Syndrome - pathology, Cell Differentiation, Coronary Angiography - methods, Coronary Vessels - pathology, Electrocardiography - methods, Gadolinium - chemistry, Magnetic Resonance Imaging - methods, Myocarditis - pathology, Myocardium - pathology, Prospective Studies, Takotsubo Cardiomyopathy - pathology, Troponin - metabolism, young adult
Editorial
01 February 2023 : Editorial
Editorial: The XBB.1.5 (‘Kraken’) Subvariant of Omicron SARS-CoV-2 and its Rapid Global SpreadDOI: 10.12659/MSM.939580
Med Sci Monit 2023; 29:e939580
SARS-CoV-2/COVID-19
19 January 2023 : Clinical Research
Evaluation of Health-Related Quality of Life and Mental Health in 729 Medical Students in Indonesia During ...Med Sci Monit In Press; DOI: 10.12659/MSM.938892
19 January 2023 : Clinical Research
Determining the Impact of the COVID-19 Pandemic on Dental Care in the Serbian Adult Population: An Online Q...Med Sci Monit 2023; 29:e939238
27 December 2022 : Clinical Research
Effect of Physiotherapy to Correct Rounded Shoulder Posture in 30 Patients During the COVID-19 Pandemic in ...Med Sci Monit 2022; 28:e938926
10 December 2022 : Clinical Research
Retrospective Study to Identify Risk Factors for Severe Disease and Mortality Using the Modified Early Warn...Med Sci Monit 2022; 28:e938647
In Press
03 Feb 2023 : Clinical Research
Treatment of Gingival Recession Defects with Pouch and Tunnel Technique Using Connective Tissue Graft and L...Med Sci Monit In Press; DOI: 10.12659/MSM.938865
02 Feb 2023 : Clinical Research
Online Questionnaire-Based Study to Evaluate the Attitudes and Use of Rubber Dental Dams by Saudi Dental Pr...Med Sci Monit In Press; DOI: 10.12659/MSM.938672
02 Feb 2023 : Database Analysis
Prognostic-Related Biomarkers in Pancreatic Ductal Adenocarcinoma Correlating with Immune Infiltrates Based...Med Sci Monit In Press; DOI: 10.12659/MSM.938785
01 Feb 2023 : Clinical Research
Comparison of 3 Enzyme-Linked Immunoassay Methods to Evaluate Serum Concentrations of Infliximab and Antibo...Med Sci Monit In Press; DOI: 10.12659/MSM.939084
Most Viewed Current Articles
13 Nov 2021 : Clinical Research
Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology ...DOI :10.12659/MSM.932788
Med Sci Monit 2021; 27:e932788
30 Dec 2021 : Clinical Research
Retrospective Study of Outcomes and Hospitalization Rates of Patients in Italy with a Confirmed Diagnosis o...DOI :10.12659/MSM.935379
Med Sci Monit 2021; 27:e935379
08 Mar 2022 : Review article
A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Man...DOI :10.12659/MSM.936292
Med Sci Monit 2022; 28:e936292
01 Jan 2022 : Editorial
Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...DOI :10.12659/MSM.935952
Med Sci Monit 2022; 28:e935952