Diagnostic and Interventional Radiology
Cardiovascular Imaging - 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 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

Diagn Interv Radiol 2019; 25: 28-34
DOI: 10.5152/dir.2018.18004
Read: 910 Downloads: 298 Published: 03 September 2019

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.

 

You may cite this article as: Abanador-Kamper N, Kamper L, Costello-Boerrigter L, Haage P, Seyfarth M. MRI findings in patients with acute coronary syndrome and unobstructed coronary arteries. Diagn Interv Radiol 2019; 25: 28–34.

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