Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries
Autor: | Jeannine A.J.M. Hermens, Jan van Es, Lodewijk J. Wagenaar, Clemens von Birgelen, Jeroen W. op den Akker |
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Přispěvatelé: | Faculty of Behavioural, Management and Social Sciences |
Rok vydání: | 2014 |
Předmět: |
Male
METIS-307065 Myocardial Infarction Contrast Media Coronary Artery Disease Coronary artery disease Electrocardiography Non-obstructed coronary arteries IR-93146 Troponin I Myocardial scarring Myocardial infarction Creatine Kinase Aged 80 and over medicine.diagnostic_test biology Middle Aged Magnetic Resonance Imaging Up-Regulation medicine.anatomical_structure Cardiology Female Radiology medicine.symptom Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Coronary circulation Cicatrix Meglumine Cardiac magnetic resonance imaging Predictive Value of Tests Internal medicine Coronary Circulation medicine Organometallic Compounds Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Retrospective Studies business.industry Microcirculation Myocardium medicine.disease Troponin Coronary arteries Cardiac MR delayed enhancement biology.protein business Biomarkers |
Zdroj: | International journal of cardiovascular imaging, 30(6), 1097-1103. Springer |
ISSN: | 1875-8312 1569-5794 |
Popis: | Patients with acute chest pain, electrocardiographic ST-elevation and significant elevation of cardiac troponin but without obstructive coronary artery disease represent a diagnostic and therapeutic dilemma. Cardiac magnetic resonance imaging (CMR) can elucidate underlying alternative causes of troponin elevation including detection of (minor) myocardial infarction (MI) by identifying myocardial scarring as delayed enhancement. Of 77 patients, who were admitted between March 2009 and December 2012 with electrocardiographic (ECG) and biochemical evidence of acute MI without obstructive coronary artery disease, 45 patients underwent CMR that showed in 11/77 (14 %) late gadolinium enhancement (LGE), compatible with myocardial scarring. We analyzed clinical, echocardiographic, and CMR data of these patients. Elevated troponin I levels were observed in all patients (median 1.3 ng/l, IQR 0.44–187) with median peak creatinine phosphokinase of 485 U/l (IQR 234–618). Echocardiographic wall motion abnormalities were detected in 8/11 (73 %) patients; in 75 % of these segments, ECG abnormalities were observed in corresponding leads. CMR detected LGE in the inferior (4/11), the inferolateral (5/11), the inferoseptal (2/11), the anterior (3/11), apical (3/11) and in the lateral segments (2/11). In addition, in all but two patients, these segments matched ECG abnormalities in corresponding leads. CMR identified microvascular obstruction in 4/11 (36 %) patients. Patients with clinical, ECG, and biochemical signs of acute MI but unobstructed coronary arteries may have CMR-detectable myocardial scars. Information on myocardial scarring may help to make the diagnosis and draw therapeutic consequences. This case series underlines the value of contrast-enhanced CMR for myocardial tissue characterization |
Databáze: | OpenAIRE |
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