Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2017; 9(6): 280-286
Published online Jun 28, 2017. doi: 10.4329/wjr.v9.i6.280
Cardiac magnetic resonance in patients with acute cardiac injury and unobstructed coronary arteries
Giovanni Salvatore Camastra, Stefano Sbarbati, Massimiliano Danti, Luca Cacciotti, Raffaella Semeraro, Sabino Walter Della Sala, Gerardo Ansalone
Giovanni Salvatore Camastra, Stefano Sbarbati, Massimiliano Danti, Luca Cacciotti, Raffaella Semeraro, Sabino Walter Della Sala, Gerardo Ansalone, Department of Cardiology and of Radiology M.G.Vannini Hospital, 00177 Roma, Italy
Author contributions: Camastra GS, Sbarbati S and Danti M performed the research and wrote the paper; Cacciotti L, Semeraro R, Della Sala SW and Ansalone G contributed to the analisys and supervised the report.
Institutional review board statement: This study was reviewed and approved by the Hospital review board. Ethics Committee approval is not requested for retrospective studies in our institution.
Informed consent statement: Patients were not required to give informed consent for participation in the study as the analyses used anonymous clinical data that were obtained after each patient agreed to treatment via written consent.
Conflict-of-interest statement: We have no financial relationship in disclosure.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Giovanni Salvatore Camastra, MD, Department of Cardiology and of Radiology M.G.Vannini Hospital, via di acqua Bullicante 4, 00177 Roma, Italy. gcamastra@virgilio.it
Telephone: +39-062-4291386 Fax: +39-062-4291418
Received: January 4, 2017
Peer-review started: January 7, 2017
First decision: February 17, 2017
Revised: May 9, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: June 28, 2017
Abstract
AIM

To define the role of cardiac magnetic resonance (CMR) by analyzing a particular group of patients with suspected acute coronary syndrome (ACS) and normal coronary angiogram.

METHODS

From January 2009 to December 2015, we examined 220 patients with clinical suspicion of ACS, Troponin elevation [the threshold used to define a positive Troponin T test (TnT) was 0.1 ng/mL] and no significant coronary disease at angiography (the patients were considered to have significant angiographic disease only a 50% stenosis was detected in any of their coronary arteries). The role of CMR with the late gadolinium enhancement was evaluated.

RESULTS

CMR was performed to 190 patients (86%) of this group which reveals: Myocarditis in 90 patients (47%); apical ballooning (Tako-Tsubo syndrome) in 32 patients (17%); myocardial infarction (MI) in 40 patients (21%) and no clear diagnosis identified by CMR in 28 patients (15%). A comparison with previous studies was also made. Clinical and echocardiographic follow-ups were performed at 12 ± 2 mo and no major adverse cardiac events were revealed.

CONCLUSION

There is a group of patients with clinical suspicion of ACS displaying normal coronary angiograms. CMR was demonstrated to be a valuable tool in the differential diagnosis evaluation of myocarditis, apical ballooning and MI.

Keywords: Magnetic resonance, Acute coronary syndrome, Troponin, Myocarditis, Coronary angiography

Core tip: In some patients with suspected acute coronary syndrome and elevated Troponin, the subsequent coronary angiography reveals normal coronaries. These patients represent an obscure and difficult field of diagnosis and investigation. There are several potential causes of this uncertainty, such as myocardial infarction with a recanalized coronary artery, myocarditis, different cardiomyopathies, and other rare conditions. Cardiac magnetic resonance offers a new and more appropriate method in distinguishing between different chest pain etiologies.