title: Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries.
abstract: To evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance (CMR) in patients with chest pain, raised troponin and unobstructed coronary arteries, and to compare subsequent event rates between diagnostic groups. 130 patients (mean age: 54 ± 17) presenting with troponin-positive acute chest pain and unobstructed coronary arteries were included. All patients were managed according to European Society of Cardiology guidelines, including echocardiography, and had CMR within 6.2 ± 5.3 days of presentation. During follow-up, major adverse cardiovascular events (MACE) were recorded. CMR provided a diagnosis in 100 of 130 patients (76.9%), with the remaining 30 (23.1%) having a normal examination. CMR diagnosed 37 (28.5%) acute myocardial infarctions, 34 (26.1%) myocarditis, 28 (21.5%) apical ballooning syndromes and 1 (0.8%) hypertrophic cardiomyopathy. When a single diagnosis was suspected by the referring physician, CMR validated this diagnosis in 32 patients (76.2%). CMR provided a formal diagnosis in 61 patients (69.3%) in which the clinical diagnosis was uncertain between at least two possibilities. CMR corrected a wrong diagnosis in 10 patients (7.7%). CMR-suggested diagnosis led to a modification of therapy in 42 patients (32.3%). Median follow-up was 34 months (interquartile range 24-49) in 124 patients. Sixteen patients (12.9%) experienced MACE. MACE rate was not different between patients with a conclusive CMR and normal CMR. In patients with acute troponin-positive chest pain and unobstructed coronary arteries, early CMR has important diagnostic and therapeutic implications. However its association with occurrence of MACE during mid term follow-up was not obvious.
authors.affiliation: Soins Intensifs Cardiologiques-Plateau de Cardiologie Interventionnelle, CHU de Bordeaux, Hopital Haut-Lévêque, 5 Avenue de Magellan, 33604, Pessac, France. edouard.gerbaud@chu-bordeaux.fr
authors.forename: Edouard
authors.initials: E
authors.lastname: Gerbaud
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Harcaut
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.forename: Matthew
authors.initials: M
authors.lastname: Erickson
authors.forename: Mathieu
authors.initials: M
authors.lastname: Lederlin
authors.forename: Jean Noel
authors.initials: JN
authors.lastname: Labèque
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Perron
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
authors.forename: Pierre
authors.initials: P
authors.lastname: Dos Santos
authors.forename: Catherine
authors.initials: C
authors.lastname: Durrieu-Jaïs
authors.forename: François
authors.initials: F
authors.lastname: Laurent
authors.forename: Michel
authors.initials: M
authors.lastname: Montaudon
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005602:France; D006331:Heart Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis; D009205:Myocarditis / Q000097:blood / Q000150:complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D020107:Troponin T