Characterization of patients with acute chest pain using cardiac magnetic resonance imaging.
OBJECTIVE
The purpose of this study was to evaluate whether CMRI provides characteristic findings in patients with acute chest pain suffering from ST-elevation-myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), acute myocarditis or Tako-tsubo cardiomyopathy.


METHODS
230 consecutive patients with acute chest pain underwent cardiac catheterization followed by CMRI within median 5 days. Patients were classified to suffer from STEMI (n = 102), NSTEMI (n = 89), acute myocarditis (n = 27), or Tako-tsubo cardiomyopathy (n = 12) on the synopsis of all clinical data. Wall motion abnormalities, late enhancement (LE), persistent microvascular obstruction as well ventricular volumes and functions were assessed by CMRI.


RESULTS
Right and left ventricular volumes were significantly different between the groups and values were highest in patients with acute myocarditis. Wall motion abnormalities were observed in 100% of STEMI, 75% of NSTEMI, 67% of acute myocarditis and 100% of Tako-tsubo patients. There was a characteristic pattern of abnormal wall motion focused on midventricular-apical segments in patients with Tako-tsubo cardiomyopathy, depending on the culprit vessel in patients with STEMI/NSTEMI and with a random distribution in patients with acute myocarditis. LE was mainly subendocardial or transmural in patients with STEMI (93.2%) or NSTEMI (62.9%). LE was diffuse, intramural or subepicardial in patients with acute myocarditis. No LE was observed in patients with Tako-tsubo cardiomyopathy. Persistent microvascular obstruction was only visualized in patients with STEMI (33%) or NSTEMI (6%).


CONCLUSIONS
Cardiac magnetic resonance imaging provides characteristic patterns of LE, persistent microvascular obstruction and wall motion abnormalities that allow a differentiation between patients with acute chest pain from coronary and non-coronary origin.
Department of Internal Medicine II, University of Ulm, Ulm, Germany. vinzenz.hombach@uniklinik-ulm.de
Vinzenz
V
Hombach
Nico
N
Merkle
Hans A
HA
Kestler
Jan
J
Torzewski
Matthias
M
Kochs
Nikolaus
N
Marx
Thorsten
T
Nusser
Christof
C
Burgstahler
Volker
V
Rasche
Peter
P
Bernhardt
Markus
M
Kunze
Jochen
J
Wöhrle
D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D002637:Chest Pain / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis*