title: The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries.
abstract: Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity worldwide. Seven to fifteen percent of patients presenting with ACS have unobstructed coronary artery disease (CAD) on urgent angiography. Patients with ACS and unobstructed coronary arteries represent a clinical dilemma and their diagnosis and management is quite variable in current practice. Cardiovascular magnetic resonance imaging with its unique non-invasive myocardial tissue characterization property has the potential to identify underlying etiologies and reach a final diagnosis. These include acute and chronic myocarditis, embolic/spontaneous recanalization myocardial infarction, and Tako-Tsubo cardiomyopathy, and other conditions. Establishing a final diagnosis has a direct implication on patient's management and prognosis. In this article, we have reviewed the current evidence on the diagnostic role of cardiac magnetic resonance (CMR) in patients with ACS and unobstructed coronary arteries. We have also highlighted the potential role of CMR as a risk stratification or prognostication tool for this patient population.
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK.
authors.forename: Amardeep Ghosh
authors.initials: AG
authors.lastname: Dastidar
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK.
authors.forename: Jonathan C L
authors.initials: JC
authors.lastname: Rodrigues
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK.
authors.forename: Nauman
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Baritussio
authors.affiliation: NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Malborough St, Bristol, BS2 8HW UK.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucciarelli-Ducci
keywords: ACS with unobstructed coronaries; Acute coronary syndrome; CMR; Myocardial infarction; Myocarditis; Tako-Tsubo cardoimyopathy; Unobstructed coronaries