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
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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