title: Diagnostic contributions of cardiac magnetic resonance imaging in patients presenting with elevated troponin, acute chest pain syndrome and unobstructed coronary arteries.
abstract: OBJECTIVE
  Myocardial infarction with unobstructed coronary artery disease represents a serious diagnostic challenge. The role of cardiac magnetic resonance in the management of cardiomyopathies is increasing. We examined the diagnostic contributions of cardiac magnetic resonance in patients presenting with acute chest pain syndrome, elevated serum cardiac troponin concentrations and no significant coronary artery stenoses.
  
  
  METHODS
  Over a 3-year period, 107 consecutive patients (mean age 43.5 years; 62% men) presented to our institution with acute onset of chest pain, elevated serum troponin concentration and unobstructed coronary arteries, and underwent 3-tesla cardiac magnetic resonance at a mean delay of 6.9 days. A diagnosis was made based on: wall motion abnormalities and pericardial effusion on cine mode; myocardial oedema on T2-weighted imaging; abnormalities on first-pass perfusion imaging; and late gadolinium enhancement on T1-weighted imaging.
  
  
  RESULTS
  Cardiac magnetic resonance was normal in 10.3% of patients and contributed a diagnosis in 89.7%, including myocarditis in 59.9%, stress cardiomyopathy (takotsubo syndrome) in 14% and myocardial infarction in 15.8%. Patients with normal cardiac magnetic resonance had a significantly lower mean peak troponin concentration (2.6ng/mL) than patients with diagnostic cardiac magnetic resonance (9.7ng/mL; P=0.01).
  
  
  CONCLUSIONS
  Cardiac magnetic resonance contributed a diagnosis in nearly 90% of patients presenting with acute chest pain, elevated serum troponin and unobstructed coronary arteries.
authors.affiliation: Service de cardiologie et maladies vasculaires, CHU de Rennes, 35033 Rennes cedex, France. guillaume.leurent@chu-rennes.fr
authors.forename: Guillaume
authors.initials: G
authors.lastname: Leurent
authors.forename: Bernard
authors.initials: B
authors.lastname: Langella
authors.forename: Claire
authors.initials: C
authors.lastname: Fougerou
authors.forename: Pierre-Axel
authors.initials: PA
authors.lastname: Lentz
authors.forename: Antoine
authors.initials: A
authors.lastname: Larralde
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulmier
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
mesh_terms: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005602:France; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009205:Myocarditis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D009942:Organometallic Compounds; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013577:Syndrome; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D014336:Troponin / Q000097:blood*; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D009942:Organometallic Compounds; D014336:Troponin; D008536:Meglumine; C072417:gadoterate meglumine