Diagnostic and Prognostic Role of CMR in MINOCA: Key Points
- 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):
- 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.
- 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.
- A systematic review and meta-analysis identified 3,624 patients across 26 studies of MINOCA; 56% of these subjects were male.
- 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.
- 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.
- 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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