The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries

Assomull, Ravi; Lyne, Jonathan; Keenan, Niall; Gulati, Ankur; Bunce, Nicholas; Davies, Simon; Pennell, Dudley J.; Prasad, Sanjay

doi:10.1093/eurheartj/ehm113

Cited by 350 publications

(251 citation statements)

References 38 publications

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“…In fact, 65% of cTn elevations in patients with negative coronary angiograms represent a true positive for heart disease, although most of these patients do not have AMI (75)(76)(77)(78). Recent guidelines also consider those cTn elevations not to be FP (58).…”

Section: Discussionmentioning

confidence: 99%

False Positive Troponin – A True Problem

Koraćević¹,

Ćosić²,

Stojanović³

2013

Journal of Medical Biochemistry

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Summary Cardiac troponins have a crucial role in diagnosing acute myocardial infarction, but have been considered by some authors to have a high false positive rate. Such opinions may decrease the confidence in troponin with important clinical consequences. The aim of the paper is to analyze three different meanings of the phrase »false positive troponin«: A) analytic (technical) false positive, with no real myocardial damage; B) false positive considering AMI: cardiac injury is present, but there is no AMI; C) false positive considering CAD: there is myocardial damage, but no CAD. The most frequent and the most important source of misunderstanding is the confusion between aspects A) and B). Namely, there has been a relatively small percentage of false positive troponin elevations due to analytic reasons. On the contrary, there has been a re - latively large percentage of »false positive« results in patients with myocardial necrosis due to causes other than AMI; for them - instead of »FP troponin elevation« - another phrase ought to be used, e.g., »non-AMI troponin elevation « until the etiopathogenesis in an individual patient is recognized. The phrase »false positive troponin« should be restricted to the artificial increase in troponin due to preanalytic and analytic reasons. By doing so, we may decrease the degree of confusion about troponin and increase the confidence in this highly specific marker of myocardial injury. The possibility of an analytic false positive result should always be kept in mind when one interprets elevated troponin.

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Section: Discussionmentioning

confidence: 99%

False Positive Troponin – A True Problem

Koraćević¹,

Ćosić²,

Stojanović³

2013

Journal of Medical Biochemistry

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“…[20][21][22][27][28][29] Prior studies using CMR perfusion imaging in patients with acute coronary syndrome and nonobstructive CAD did not include stress testing. [16][17][18][19]30,31 Adenosine stress perfusion CMR is highly sensitive, specific, and reproducible for identification of obstructive CAD and has been reported to be superior to other stress imaging methods for this purpose. [32][33][34][35][36][37][38] In the setting of stable, nonobstructive CAD, patients with proven microvascular disease based on invasive coronary reactivity testing had lower MPRI as compared with healthy controls.…”

Section: Cmr Evidence Of Infarction (Lge)mentioning

confidence: 99%

“…13 Advanced imaging modalities, including intravascular imaging and cardiac magnetic resonance imaging (CMR), may help to characterize MI etiology in these patients. [14][15][16][17][18][19] Microvascular coronary disease is a known cause of chest pain with nonobstructive CAD. 20 Abnormal coronary flow reserve is a predictor of adverse outcomes, including death, in stable patients with nonobstructive CAD.…”

Section: Introductionmentioning

confidence: 99%

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

Mauricio

Srichai

Axel

et al. 2016

Clinical Cardiology

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BackgroundIn a prospective study, cardiac MRI (CMR) and intravascular ultrasound were performed in women with myocardial infarction (MI) and nonobstructive coronary artery disease (MINOCA). Forty participants underwent adenosine‐stress CMR (sCMR).HypothesisAbnormal perfusion may co‐localize with ischemic late gadolinium enhancement (LGE) and T2‐weighted signal hyperintensity (T2+), suggesting microvascular dysfunction contributed to MI.MethodsQualitative perfusion analysis was performed by 2 independent readers. Abnormal myocardial perfusion reserve index (MPRI) was defined as global average ≤1.84.ResultsAbnormal rest perfusion was present in 10 patients (25%) and stress perfusion abnormalities in 25 (63%). Abnormal stress perfusion was not associated with LGE but tended to occur with T2+. Among patients with abnormal perfusion and LGE, the LGE pattern was ischemic in half. The locations of abnormal perfusion and LGE matched in 75%, T2+ in 100%. Abnormal stress perfusion was not associated with plaque disruption and matched in location in 63%. MPRI was abnormal in 10 patients (25%) and was not associated with LGE, T2+ or plaque disruption.ConclusionsAbnormal perfusion on sCMR is common among women with MINOCA. Abnormal perfusion usually co‐localized with LGE and/or T2+ when present. Variability in LGE pattern leads to uncertainty about whether the finding of abnormal perfusion was cause or consequence of the tissue state leading to LGE. Low MPRI, possibly indicating diffuse microvascular disease, was observed with and without LGE and T2+. Multiple mechanisms may lead to abnormal perfusion on sCMR. Microvascular dysfunction may contribute to the pathogenesis of and coexist with other causes of MINOCA.

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“…Myocarditis has been frequently associated in patients with acute chest pain syndrome and angiographically normal coronary arteries [1] . When the clinical presentation plus dynamic electrocardiographic (ECG) changes is quite suggestive of an acute coronary syndrome, coronary angiography is currently the first imaging diagnostic assessment in this setting.…”

Section: Introductionmentioning

confidence: 99%

Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

Kumar

Bagur

Béliveau

et al. 2014

WJC

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A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause. Key words: Myocarditis; Acute coronary syndrome; Coronary spasm; Myocardial infarction Core tip: The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause of coronary spasm presenting with ST-segment elevation myocardial infarction in a young healthy man.Kumar A, Bagur R, Béliveau P, Potvin JM, Levesque P, Fillion N, Tremblay B, Larose É, Gaudreault V. Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction.

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The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries

Abstract: CMR is a valuable adjunct to conventional investigations in a diagnostically challenging and important group of patients with troponin-positive chest pain and unobstructed coronary arteries.

Cited by 350 publications

References 38 publications

False Positive Troponin – A True Problem

False Positive Troponin – A True Problem

Stress Cardiac MRI in Women With Myocardial Infarction and Nonobstructive Coronary Artery Disease

Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

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