title: Troponin-positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI.
abstract: OBJECTIVE
  The purpose of this study was to assess the outcome of cardiac MRI (CMRI) with late gadolinium enhancement (LGE) at outpatient follow-up in a consecutive series of patients with troponin-positive chest pain but unobstructed coronary arteries at the index admission.
  
  
  METHODS
  The study group comprised 91 consecutive patients who presented to our institution with cardiac chest pain, elevated troponin I and unobstructed coronary arteries on coronary angiography. All patients underwent an outpatient CMRI with LGE imaging in order to establish a definitive diagnosis.
  
  
  RESULTS
  The average time from coronary angiography to LGE-CMRI was 2 months. 73% of patients had no abnormality on their LGE-CMRI, 16% of patients had patchy late enhancement consistent with myocarditis and 11% had focal subendocardial or full thickness late enhancement consistent with myocardial infarction. There were no deaths in this cohort during a mean follow-up of 21 months.
  
  
  CONCLUSIONS
  LGE-CMRI is a useful tool for establishing whether such patients have definitive evidence of non-ST-segment elevation myocardial infarction (NSTEMI), and can make an important contribution to the long-term management strategy of these patients as an inappropriate diagnosis of NSTEMI carries important medical, social and financial implications.
authors.affiliation: Department of Cardiology, Southampton University Hospitals NHS Trust, Southampton, UK.
authors.forename: M
authors.initials: M
authors.lastname: Mahmoudi
authors.forename: S
authors.initials: S
authors.lastname: Harden
authors.forename: N
authors.initials: N
authors.lastname: Abid
authors.forename: C
authors.initials: C
authors.lastname: Peebles
authors.forename: Z
authors.initials: Z
authors.lastname: Nicholas
authors.forename: T
authors.initials: T
authors.lastname: Jones
authors.forename: D
authors.initials: D
authors.lastname: McKenzie
authors.forename: N
authors.initials: N
authors.lastname: Curzen
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000033:anatomy & histology*; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D003287:Contrast Media; D019210:Troponin I; D019786:Gadolinium DTPA