title: Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries.
abstract: OBJECTIVE
  To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram.
  
  
  METHODS
  This study included a total of 125 patients treated in the chest pain unit during a 39-month period. Each included patient underwent MRI within a median of 3 days after cardiac catheterization. The MRI protocol comprised cine, oedema-sensitive and late gadolinium-enhancement imaging. The standard of reference was a consensus diagnosis based on clinical follow-up and the synopsis of all clinical, laboratory and imaging data.
  
  
  RESULTS
  MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hypertensive heart disease, hypertrophic CM, cardiac amyloidosis and non-compaction CM. MRI-based diagnoses were the same as the final reference diagnoses in 113/125 patients (90%), with the two diagnoses differing in only 12/125 patients. In two patients, no final diagnosis could be established.
  
  
  CONCLUSIONS
  CMR performed early after the onset of symptoms revealed a broad spectrum of diseases. CMR delivered a correct final diagnosis in 90% of patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram.
  
  
  CONCLUSIONS
  Diagnosing patients with acute coronary syndrome but unobstructed coronary arteries remains a challenge for cardiologists. CMR performed early after catheterization reveals a broad spectrum of diseases with only a simple and quick examination protocol, and there is a high concordance between MRI-based diagnoses and final reference diagnoses.
authors.affiliation: 1 Department of Diagnostic and Interventional Radiology, Universitätsmedizin, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Emrich
authors.forename: K
authors.initials: K
authors.lastname: Emrich
authors.forename: N
authors.initials: N
authors.lastname: Abegunewardene
authors.forename: K
authors.initials: K
authors.lastname: Oberholzer
authors.forename: C
authors.initials: C
authors.lastname: Dueber
authors.forename: T
authors.initials: T
authors.lastname: Muenzel
authors.forename: K-F
authors.initials: KF
authors.lastname: Kreitner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000201:enzymology; D002637:Chest Pain / Q000175:diagnosis / Q000201:enzymology; D003287:Contrast Media; D017023:Coronary Angiography; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D019786:Gadolinium DTPA