Diagnostic and Prognostic Role of CMR in MINOCA: Key Points

Mar 08, 2023   |  Venkatesh Locharla Murthy, MD, PhD, FACC
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Authors:
Mileva N, Paolisso P, Gallinoro E, et al.
Citation:
Diagnostic and Prognostic Role of Cardiac Magnetic Resonance in MINOCA: Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023;16:376-389.

The following are key points to remember from a systematic review and meta-analysis on the diagnostic and prognostic role of cardiac magnetic resonance (CMR) in myocardial infarction with nonobstructive coronary arteries (MINOCA):

  1. The criteria for diagnosing MINOCA are: a) acute myocardial infarction meeting the fourth universal definition of myocardial infarction; 2) coronary angiography showing no stenosis ≥50%; and 3) no alternative, overt cause.
  2. The European Society of Cardiology guidelines for management of acute coronary syndrome recommend use of cardiac magnetic resonance (CMR) imaging to elucidate underlying diagnoses in patients with MINOCA.
  3. A systematic review and meta-analysis identified 3,624 patients across 26 studies of MINOCA; 56% of these subjects were male.
  4. In this systematic review and meta-analysis, CMR enabled identification of a definite alternative diagnosis in 63% of subjects: 31% were diagnosed with myocarditis and 10% were diagnosed with stress cardiomyopathy; 22% were confirmed to have MINOCA.
  5. Among 770 patients across five studies, a confirmed diagnosis of MINOCA by CMR was associated with a 2.4-fold increased risk of major adverse cardiac events.
  6. CMR protocols for MINOCA are recommended to include late gadolinium enhancement (LGE) imaging to identify patterns of scar/fibrosis and T2 imaging or T1/T2 mapping sequences to identify areas of edema or acute injury. Patients with ischemic patterns on CMR may warrant review of angiography and consideration of intravascular imaging and/or assessment of coronary physiology.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and ACS, Interventions and Imaging, Angiography, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Cardiomyopathies, Cicatrix, Contrast Media, Coronary Angiography, Diagnostic Imaging, Edema, Gadolinium, Magnetic Resonance Imaging, Myocardial Infarction, Myocardial Ischemia, Myocarditis, Prognosis


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