Early cardiac magnetic resonance imaging in troponin-positive acute chest pain and non-obstructed coronary arteries.
OBJECTIVE
We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries.


METHODS
In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out.


RESULTS
CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality.


CONCLUSIONS
CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.
['Vágó|Hajnalka|H|0000-0002-3568-3572', 'Szabó|Liliána|L|0000-0002-4699-3648', 'Dohy|Zsófia|Z|', 'Czimbalmos|Csilla|C|', 'Tóth|Attila|A|', 'Suhai|Ferenc Imre|FI|', 'Bárczi|György|G|', 'Gyarmathy|V Anna|VA|', 'Becker|Dávid|D|', 'Merkely|Béla|B|']
D000328:Adult D000368:Aged D000787:Angina Pectoris D015415:Biomarkers D003324:Coronary Artery Disease D016208:Databases, Factual D003937:Diagnosis, Differential D005260:Female D006801:Humans D008137:Longitudinal Studies D019028:Magnetic Resonance Imaging, Cine D008297:Male D008875:Middle Aged D000071956:Myocardial Contusions D009203:Myocardial Infarction D009205:Myocarditis D011237:Predictive Value of Tests D011379:Prognosis D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D054549:Takotsubo Cardiomyopathy D013997:Time Factors D014336:Troponin D055815:Young Adult
myocarditis acute myocardial infarction cardiac magnetic resonance (CMR) imaging