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Characterization of patients with acute chest pain using cardiac magnetic resonance imaging

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Abstract

Aims

The purpose of this study was to evaluate whether CMRI provides characteristic findings in patients with acute chest pain suffering from ST-elevation-myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), acute myocarditis or Tako-tsubo cardiomyopathy.

Patients and methods

230 consecutive patients with acute chest pain underwent cardiac catheterization followed by CMRI within median 5 days. Patients were classified to suffer from STEMI (n = 102), NSTEMI (n = 89), acute myocarditis (n = 27), or Tako-tsubo cardiomyopathy (n = 12) on the synopsis of all clinical data. Wall motion abnormalities, late enhancement (LE), persistent microvascular obstruction as well ventricular volumes and functions were assessed by CMRI.

Results

Right and left ventricular volumes were significantly different between the groups and values were highest in patients with acute myocarditis. Wall motion abnormalities were observed in 100% of STEMI, 75% of NSTEMI, 67% of acute myocarditis and 100% of Tako-tsubo patients. There was a characteristic pattern of abnormal wall motion focused on midventricular-apical segments in patients with Tako-tsubo cardiomyopathy, depending on the culprit vessel in patients with STEMI/NSTEMI and with a random distribution in patients with acute myocarditis. LE was mainly subendocardial or transmural in patients with STEMI (93.2%) or NSTEMI (62.9%). LE was diffuse, intramural or subepicardial in patients with acute myocarditis. No LE was observed in patients with Tako-tsubo cardiomyopathy. Persistent microvascular obstruction was only visualized in patients with STEMI (33%) or NSTEMI (6%).

Conclusions

Cardiac magnetic resonance imaging provides characteristic patterns of LE, persistent microvascular obstruction and wall motion abnormalities that allow a differentiation between patients with acute chest pain from coronary and non-coronary origin.

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Authors and Affiliations

  1. Department of Internal Medicine II, University of Ulm, Robert-Koch-Straße 8, 89081, Ulm, Germany

    Vinzenz Hombach, Nico Merkle, Jan Torzewski, Matthias Kochs, Nikolaus Marx, Thorsten Nusser, Volker Rasche, Peter Bernhardt, Markus Kunze & Jochen Wöhrle

  2. Department of Internal Medicine III, University of Tübingen, Tübingen, Germany

    Christof Burgstahler

  3. Bioinformatics, University of Ulm, Ulm, Germany

    Hans A. Kestler

Authors
  1. Vinzenz Hombach
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  2. Nico Merkle
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  3. Hans A. Kestler
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  4. Jan Torzewski
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  5. Matthias Kochs
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  6. Nikolaus Marx
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  8. Christof Burgstahler
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  9. Volker Rasche
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  10. Peter Bernhardt
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  11. Markus Kunze
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  12. Jochen Wöhrle
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Corresponding author

Correspondence to Vinzenz Hombach.

Additional information

Supported in part by an unrestricted grant of Philips Medical Systems Best, The Netherlands, and Hamburg, Germany.

For paper handling: jochen.woehrle@uniklinik-ulm.de

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Hombach, V., Merkle, N., Kestler, H.A. et al. Characterization of patients with acute chest pain using cardiac magnetic resonance imaging. Clin Res Cardiol 97, 760–767 (2008). https://doi.org/10.1007/s00392-008-0675-4

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  • DOI: https://doi.org/10.1007/s00392-008-0675-4

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