E-ISSN: 1305-3612
MRI findings in patients with acute coronary syndrome and unobstructed coronary arteries
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Cardiovascular Imaging - Original Article
VOLUME: 25 ISSUE: 1
P: 28-34
January 2019

MRI findings in patients with acute coronary syndrome and unobstructed coronary arteries

Diagn Interv Radiol 2019;25(1):28-34
DOI: 10.5152/dir.2018.18004
Nadine Abanador-Kamper 1
Lars Kamper 2
Lisa Costello-Boerrigter 3
Patrick Haage 4
Melchior Seyfarth 4
1. Department of Cardiology, HELIOS University Hospital, Wuppertal, Germany; Center for Clinical Medicine, University Faculty of Health, Witten/Herdecke, Germany
2. Department of Diagnostic 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
4. Center for Clinical Medicine,University Faculty of Health, Witten/Herdecke, Germany
No information available.
No information available
Received Date: 09.01.2018
Accepted Date: 06.06.2018
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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 magnetic resonance imaging (MRI) in this clinical setting.

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 Takotsubo syndrome (TTS), new onset of heart failure with a left ventricular ejection fraction (LVEF) <30%, and occurrence of a new left ventricular thrombus formation.

RESULTS:

Final diagnoses included acute myocardial infarction (AMI) (40%), acute myocarditis (24%) and TTS (33%). In 3% of patients, nonspecific 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 edema 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 with patients with a final diagnosis of AMI or myocarditis.