Timing of cardiac magnetic resonance and diagnostic yield in patients with myocardial infarction with nonobstructive coronary arteries

Rev Esp Cardiol (Engl Ed). 2024 Jul;77(7):515-523. doi: 10.1016/j.rec.2023.11.013. Epub 2023 Dec 5.
[Article in English, Spanish]

Abstract

Introduction and objectives: The present study sought to establish the diagnostic yield of cardiovascular magnetic resonance (CMR) in a large cohort of patients admitted with myocardial infarction (MI) with nonobstructive coronary artery disease (MINOCA) based on the timing of referral to CMR.

Methods: Consecutive patients referred to CMR from January 2009 to February 2022 with a working diagnosis of MINOCA were retrospectively evaluated. Cine, T2-weighted, early, and late gadolinium-enhanced images were acquired and analyzed. The frequency of the underlying diagnosis and the association between timing of CMR and relative frequency of each diagnosis were assessed.

Results: We included 207 patients (median age 50 years, 60% men). Final diagnosis after CMR was achieved in 91% of the patients (myocarditis in 45%, MI in 20%, tako-tsubo cardiomyopathy in 19%, and other cardiomyopathies in 7%). The performance of CMR within 7 days of admission with MINOCA (median, 5 days; 117 patients) allowed a higher diagnostic yield compared with CMR performed later (median, 10 days; 88 patients) (96% vs 86%, P=.02). Although myocarditis was the most frequent diagnosis in both groups according to time to CMR, its frequency was higher among patients with a CMR performed within the first 7 days (53% vs 35%, P=.02). The frequency of other underlying diagnoses was not influenced by CMR timing.

Conclusions: CMR led to an underlying diagnosis of MINOCA in 91% of patients and its diagnostic yield increased to 96% when CMR was performed within 7 days of admission. The most frequent diagnosis was myocarditis..

Keywords: Cardiac imaging technique; Cardiac magnetic resonance; Enfermedad de las arterias coronarias no obstructiva; Infarto de miocardio; Miocarditis; Myocardial infarction; Myocarditis; Nonobstructive coronary artery disease; Resonancia magnética cardiaca; Técnica de imagen cardiaca.

MeSH terms

  • Adult
  • Aged
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnosis
  • Coronary Vessels / diagnostic imaging
  • Female
  • Humans
  • MINOCA / diagnosis
  • Magnetic Resonance Imaging, Cine* / methods
  • Male
  • Middle Aged
  • Myocardial Infarction* / diagnosis
  • Myocarditis / diagnosis
  • Myocarditis / diagnostic imaging
  • Retrospective Studies
  • Time Factors