Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms.

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State: Public
Version: author
Serval ID
serval:BIB_CAC10FF6FE47
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Diagnostic contribution of cardiac magnetic resonance in patients with acute coronary syndrome and culprit-free angiograms.
Journal
Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
Author(s)
Kawecki D., Morawiec B., Monney P., Pellaton C., Wojciechowska C., Jojko J., Basiak M., Przywara-Chowaniec B., Fournier S., Nowalany-Kozielska E., Schwitter J., Muller O.
ISSN
1643-3750 (Electronic)
ISSN-L
1234-1010
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
21
Pages
171-180
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
BACKGROUND: In spite of robust knowledge about underlying ischemic myocardial damage, acute coronary syndromes (ACS) with culprit-free angiograms raise diagnostic concerns. The present study aimed to evaluate the additional value of cardiac magnetic resonance (CMR) over commonly available non-CMR standard tests, for the differentiation of myocardial injury in patients with ACS and non-obstructed coronary arteries.
MATERIAL/METHODS: Patients with ACS, elevated hs-TnT, and a culprit-free angiogram were prospectively enrolled into the study between January 2009 and July 2013. After initial evaluation with standard tests (ECG, echocardiography, hs-TnT) and provisional exclusion of acute myocardial infarction (AMI) in coronary angiogram, patients were referred for CMR with the suspicion of myocarditis or Takotsubo cardiomyopathy (TTC). According to the result of CMR, patients were reclassified as having myocarditis, AMI, TTC, or non-injured myocardium as assessed by late gadolinium enhancement.
RESULTS: Out of 5110 patients admitted with ACS, 75 had normal coronary angiograms and entered the study; 69 of them (92%) were suspected for myocarditis and 6 (8%) for TTC. After CMR, 49 patients were finally diagnosed with myocarditis (65%), 3 with TTC (4%), 7 with AMI (9%), and 16 (21%) with non-injured myocardium. The provisional diagnosis was changed or excluded in 23 patients (31%), with a 9% rate of unrecognized AMI.
CONCLUSIONS: The study results suggest that the evaluation of patients with ACS and culprit-free angiogram should be complemented by a CMR examination, if available, because the initial work-up with non-CMR tests leads to a significant proportion of misdiagnosed AMI.
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16/02/2015 14:17
Last modification date
20/08/2019 15:45
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