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

Gladys Juncà; Albert Teis; Gizem Kasa; Elena Ferrer-Sistach; Nuria Vallejo; Jorge López-Ayerbe; Germán Cediel; Antoni Bayés-Genís; Victoria Delgado

doi:10.1016/j.rec.2023.11.013

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

Rev Esp Cardiol (Engl Ed). 2023 Dec 5:S1885-5857(23)00339-0. doi: 10.1016/j.rec.2023.11.013. Online ahead of print.

[Article in English, Spanish]

Authors

Gladys Juncà¹, Albert Teis¹, Gizem Kasa¹, Elena Ferrer-Sistach¹, Nuria Vallejo¹, Jorge López-Ayerbe¹, Germán Cediel², Antoni Bayés-Genís², Victoria Delgado³

Affiliations

¹ Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
² Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
³ Instituto del Corazón, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain. Electronic address: vdelgadog.germanstrias@gencat.cat.

PMID: 38061424
DOI: 10.1016/j.rec.2023.11.013

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.