Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries

Jeannine A.J.M. Hermens, Jan van Es, Clemens von Birgelen, Jeroen W. op den Akker, Lodewijk J. Wagenaar

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)

Abstract

Patients with acute chest pain, electrocardiographic ST-elevation and significant elevation of cardiac troponin but without obstructive coronary artery disease represent a diagnostic and therapeutic dilemma. Cardiac magnetic resonance imaging (CMR) can elucidate underlying alternative causes of troponin elevation including detection of (minor) myocardial infarction (MI) by identifying myocardial scarring as delayed enhancement. Of 77 patients, who were admitted between March 2009 and December 2012 with electrocardiographic (ECG) and biochemical evidence of acute MI without obstructive coronary artery disease, 45 patients underwent CMR that showed in 11/77 (14 %) late gadolinium enhancement (LGE), compatible with myocardial scarring. We analyzed clinical, echocardiographic, and CMR data of these patients. Elevated troponin I levels were observed in all patients (median 1.3 ng/l, IQR 0.44–187) with median peak creatinine phosphokinase of 485 U/l (IQR 234–618). Echocardiographic wall motion abnormalities were detected in 8/11 (73 %) patients; in 75 % of these segments, ECG abnormalities were observed in corresponding leads. CMR detected LGE in the inferior (4/11), the inferolateral (5/11), the inferoseptal (2/11), the anterior (3/11), apical (3/11) and in the lateral segments (2/11). In addition, in all but two patients, these segments matched ECG abnormalities in corresponding leads. CMR identified microvascular obstruction in 4/11 (36 %) patients. Patients with clinical, ECG, and biochemical signs of acute MI but unobstructed coronary arteries may have CMR-detectable myocardial scars. Information on myocardial scarring may help to make the diagnosis and draw therapeutic consequences. This case series underlines the value of contrast-enhanced CMR for myocardial tissue characterization
Original languageEnglish
Pages (from-to)1097-1103
JournalInternational journal of cardiovascular imaging
Volume30
Issue number6
DOIs
Publication statusPublished - 2014

Keywords

  • METIS-307065
  • IR-93146
  • Myocardial infarction
  • Non-obstructed coronary arteries
  • Cardiac MR delayed enhancement
  • Myocardial scarring

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