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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

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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.

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Authors and Affiliations

  1. Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands

    Jeannine A. J. M. Hermens, Jan van Es, Clemens von Birgelen & Lodewijk J. Wagenaar

  2. Department of Radiology, Ziekenhuisgroep Twente, Almelo, The Netherlands

    Jeroen W. op den Akker

  3. Department of Health Technology and Services Research, MIRA-Institute, University of Twente, Enschede, The Netherlands

    Clemens von Birgelen

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  1. Jeannine A. J. M. Hermens
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  2. Jan van Es
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  5. Lodewijk J. Wagenaar
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Correspondence to Jeannine A. J. M. Hermens.

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Hermens, J.A.J.M., van Es, J., von Birgelen, C. et al. 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. Int J Cardiovasc Imaging 30, 1097–1103 (2014). https://doi.org/10.1007/s10554-014-0435-7

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  • DOI: https://doi.org/10.1007/s10554-014-0435-7

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