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Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries

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Abstract

To evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance (CMR) in patients with chest pain, raised troponin and unobstructed coronary arteries, and to compare subsequent event rates between diagnostic groups. 130 patients (mean age: 54 ± 17) presenting with troponin-positive acute chest pain and unobstructed coronary arteries were included. All patients were managed according to European Society of Cardiology guidelines, including echocardiography, and had CMR within 6.2 ± 5.3 days of presentation. During follow-up, major adverse cardiovascular events (MACE) were recorded. CMR provided a diagnosis in 100 of 130 patients (76.9%), with the remaining 30 (23.1%) having a normal examination. CMR diagnosed 37 (28.5%) acute myocardial infarctions, 34 (26.1%) myocarditis, 28 (21.5%) apical ballooning syndromes and 1 (0.8%) hypertrophic cardiomyopathy. When a single diagnosis was suspected by the referring physician, CMR validated this diagnosis in 32 patients (76.2%). CMR provided a formal diagnosis in 61 patients (69.3%) in which the clinical diagnosis was uncertain between at least two possibilities. CMR corrected a wrong diagnosis in 10 patients (7.7%). CMR-suggested diagnosis led to a modification of therapy in 42 patients (32.3%). Median follow-up was 34 months (interquartile range 24–49) in 124 patients. Sixteen patients (12.9%) experienced MACE. MACE rate was not different between patients with a conclusive CMR and normal CMR. In patients with acute troponin-positive chest pain and unobstructed coronary arteries, early CMR has important diagnostic and therapeutic implications. However its association with occurrence of MACE during mid term follow-up was not obvious.

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Authors and Affiliations

  1. Soins Intensifs Cardiologiques—Plateau de Cardiologie Interventionnelle, CHU de Bordeaux, Hopital Haut-Lévêque, 5 Avenue de Magellan, 33604, Pessac, France

    Edouard Gerbaud, Emmanuel Harcaut, Pierre Coste, Matthew Erickson, Pierre Dos Santos & Catherine Durrieu-Jaïs

  2. Unité d’Imagerie Thoracique et Cardiovasculaire, CHU de Bordeaux, 5 Avenue de Magellan, 33604, Pessac, France

    Mathieu Lederlin, Hubert Cochet, François Laurent & Michel Montaudon

  3. Service de Cardiologie, CH Cote Basque, 13 Avenue de l’interne J. Loeb, 64109, Bayonne, France

    Jean Noel Labèque

  4. Service de Cardiologie, CH Robert Boulin, 112 rue de la Marne, 33500, Libourne, France

    Jean Marie Perron

  5. INSERM U885, Université de Bordeaux, 146 rue Léo Saignat, 33076, Bordeaux, France

    François Laurent & Michel Montaudon

Authors
  1. Edouard Gerbaud
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  2. Emmanuel Harcaut
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  3. Pierre Coste
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  4. Matthew Erickson
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  5. Mathieu Lederlin
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  6. Jean Noel Labèque
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  7. Jean Marie Perron
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  8. Hubert Cochet
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  9. Pierre Dos Santos
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  10. Catherine Durrieu-Jaïs
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  11. François Laurent
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  12. Michel Montaudon
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Correspondence to Edouard Gerbaud.

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Gerbaud, E., Harcaut, E., Coste, P. et al. Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Int J Cardiovasc Imaging 28, 783–794 (2012). https://doi.org/10.1007/s10554-011-9879-1

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  • DOI: https://doi.org/10.1007/s10554-011-9879-1

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