E-ISSN 1305-3612
Original Article
MRI findings in patients with acute coronary syndrome and unobstructed coronary arteries
1 Department of Cardiology, HELIOS University Hospital, Wuppertal, Germany; Center for Clinical Medicine, University Faculty of Health, Witten/Herdecke, Germany  
2 Department of Diagnostic and Interventional Radiology, HELIOS University Hospital, Wuppertal, Germany; Center for Clinical Medicine, University Faculty of Health, Witten/Herdecke, Germany  
3 HELIOS Research Center- Region Mitte, Medical Clinic 3, HELIOS Clinic - Erfurt, Erfurt, Germany  
Diagn Interv Radiol ; : -

Abstract

 

Purpose: The underlying diagnosis in patients with acute coronary syndrome (ACS) and unobstructed coronary arteries remains a diagnostic challenge. We analyzed the value of MRI in this clinical setting.

 

Materials and Methods: A total of 213 patients with ACS and unobstructed coronary arteries underwent MRI within a median of 2 days after initial presentation. Clinical, laboratory and MRI data were analyzed. A consensus diagnosis was established for each case by an independent panel after reviewing the individual clinical, laboratory and MRI data. Standardized interviews to determine patient outcomes were carried out after a median follow-up of 24-months. Clinical events were defined as a composite of death, stroke, myocardial infarction or recurrence of TTS, new onset of heart failure with a left ventricular ejection fraction (LVEF) < 30%, and occurrence of a new LV thrombus formation.

 

Results: Final diagnoses included acute myocardial infarction (AMI) (40%), acute myocarditis (24%) and Takotsubo Syndrome (TTS) (33%). In 3% of patients, non-specific findings lead to an indeterminate diagnosis. Patients with TTS showed a significantly impaired LVEF during the index event (50% vs. 60% in AMI and 60% in myocarditis, P=0.001). The extent of myocardial oedema was most pronounced in patients with TTS (13.4%±11.4 vs. 4.6%±7.9 in AMI and 1.8%±2.7 in myocarditis, P<0.001). TTS patients had the highest event rate (16.9%).

 

Conclusion: Our study emphasizes the diagnostic utility of timely MRI in patients with ACS and unobstructed coronary arteries. We found a high prevalence of TTS patients, who had poorer outcomes compared to patients with a final diagnosis of AMI or myocarditis.

 

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