Cardiac MRI in Patients with Acute Chest Pain

Abstract

Acute chest pain is a common reason for visits to the emergency department. It is important to distinguish among the various causes of acute chest pain, because treatment and prognosis are substantially different among the various conditions. It is critical to exclude acute coronary syndrome (ACS), which is a major cause of hospitalization, death, and health care costs worldwide. Myocardial ischemia is defined as potential myocyte death secondary to an imbalance between oxygen supply and demand due to obstruction of an epicardial coronary artery. Unobstructed coronary artery disease can have cardiac causes (eg, myocarditis, myocardial infarction with nonobstructed coronary arteries, and Takotsubo cardiomyopathy), and noncardiac diseases can manifest with acute chest pain and increased serum cardiac biomarker levels. In the emergency department, cardiac MRI may aid in the identification of patients with non-STsegment elevation myocardial infarction or unstable angina or ACS with unobstructed coronary artery disease, if the patient's clinical history is known to be atypical. Also, cardiac MRI is excellent for risk stratification of patients for adverse left ventricular remodeling or major adverse cardiac events. Cardiac MRI should be performed early in the course of the disease (<2 weeks after onset of symptoms). Steady-state free-precession T2-weighted MRI with late gadolinium enhancement is the mainstay of the cardiac MRI protocol. Further sequences can be used to analyze the different pathophysiologic subjacent mechanisms of the disease, such as microvascular obstruction or intramyocardial hemorrhage. Finally, cardiac MRI may provide several prognostic biomarkers that help in follow-up of these patients.

Early MRI on transmural infarction and epistenocardic pericarditis with normal coronariography

“…Hence, in cases where angiography is not clarifying, cardiac MRI allows establishment of final diagnosis, helps detection of complications and further risk stratification for future major cardiac events. 1,5,8 Thus, this case shows the importance of performing cardiac MRI in an early phase and, consequently the correct treatment orientation.…”

“…7 Hence, in cases where angiography is not clarifying, cardiac MRI allows characterization, detection of complications and risk stratification for future major cardiac events. 1,5,8 According to these findings, we believe that the administration of heparin dissolved the occlusion within the culprit vessel, although the lesion had already progressed and evolved to an established transmural infarction with central core of MVO. Along with this rapidly progressed event, it was associated with an epistenocardic pericarditis complication.…”

“…STEMI patients account for 25 to 35% of Acute Coronary Syndrome (ACS) and demand rapid reperfusion therapy. 1,2 It is usually caused by acute occlusion of a coronary artery or its main branch by thrombosis of preexisting coronary atherosclerosis and plaque rupture. 3 Very often they progress to transmural infarction.…”

Cardiac magnetic resonance imaging in acute and chronic myocardial ischemia: current clinical application and future directions

“…Още по-точен прогностичен белег за оценка на възстановяването на миокардната кинетика е изчисляването на екстрацелуларния обем с контрастно усилено Т1 картографиране [23].…”

“…An even more accurate prognostic marker to assess the recovery of myocardial kinetics is the calculation of extracellular volume with contrast-enhanced T1 mapping [23].…”