How to Use Cardiac Magnetic Resonance Imaging in Myocardial Infarction With Nonobstructive Coronary Arteries.

Autor:	Tornvall P; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden (P.T.)., Beltrame JF; University of Adelaide, Central Adelaide Local Health Network, Basil Hetzel Institute, Australia (J.F.B.)., Nickander J; Department of Molecular Medicine and Surgery (J.N.), Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden., Sörensson P; Department of Medicine Solna (P.S.), Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden., Reynolds HR; Sarah Ross Soter Center for Women's Cardiovascular Research, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (H.R.R.)., Agewall S; Clinical Science, Oslo University, Norway (S.A.).; Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (S.A.).
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular imaging [Circ Cardiovasc Imaging] 2024 Jul; Vol. 17 (7), pp. e016463. Date of Electronic Publication: 2024 Jul 16.
DOI:	10.1161/CIRCIMAGING.123.016463
Abstrakt:	The working diagnosis Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA) is being increasingly recognized with the common use of high-sensitivity troponins and coronary angiography, accounting for 5% to 10% of all acute myocardial infarction presentations. Cardiac magnetic resonance (CMR) imaging is pivotal in patients presenting with suspected MINOCA, mainly to delineate those with a nonischemic cause, for example, myocarditis and Takotsubo syndrome, from those with true ischemic myocardial infarction, that is, MINOCA. The optimal timing for CMR imaging in patients with suspected MINOCA has been uncertain and, until recently, not been examined prospectively. Previous retrospective studies have indicated that the diagnostic yield decreases with time from the acute event. The SMINC studies (Stockholm Myocardial Infarction with Normal Coronaries) show that CMR should be performed early in all patients with the working diagnosis of MINOCA, with the possible exception of patients who are clearly identified as having Takotsubo syndrome as determined by echocardiography. In addition to CMR imaging, other investigations of importance in selected patients may be pulmonary artery computed tomography to exclude pulmonary embolism, optical coherence tomography to identify plaque disruption, and acetylcholine provocation to identify coronary artery spasm. Imaging of patients with the working diagnosis MINOCA, which is centered on CMR together with supplemental investigations, results in a clear diagnosis in approximately three-quarters of the patients. This is a good example of personalized medicine, because a correct diagnosis will not only increase the satisfaction of the individual patient but also result in optimizing treatment without harming the patient. Competing Interests: Dr Reynolds has received unrestricted donations from Abbott and Siemens. Dr Nickander received speaker fees from Sanofi Genzyme.
Databáze:	MEDLINE
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