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The International Journal of Cardiovascular Imaging

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01-08-2014 | Original Paper

Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries

Authors: Jeannine A. J. M. Hermens, Jan van Es, Clemens von Birgelen, Jeroen W. op den Akker, Lodewijk J. Wagenaar

Published in: The International Journal of Cardiovascular Imaging | Issue 6/2014

Abstract

Patients with acute chest pain, electrocardiographic ST-elevation and significant elevation of cardiac troponin but without obstructive coronary artery disease represent a diagnostic and therapeutic dilemma. Cardiac magnetic resonance imaging (CMR) can elucidate underlying alternative causes of troponin elevation including detection of (minor) myocardial infarction (MI) by identifying myocardial scarring as delayed enhancement. Of 77 patients, who were admitted between March 2009 and December 2012 with electrocardiographic (ECG) and biochemical evidence of acute MI without obstructive coronary artery disease, 45 patients underwent CMR that showed in 11/77 (14 %) late gadolinium enhancement (LGE), compatible with myocardial scarring. We analyzed clinical, echocardiographic, and CMR data of these patients. Elevated troponin I levels were observed in all patients (median 1.3 ng/l, IQR 0.44–187) with median peak creatinine phosphokinase of 485 U/l (IQR 234–618). Echocardiographic wall motion abnormalities were detected in 8/11 (73 %) patients; in 75 % of these segments, ECG abnormalities were observed in corresponding leads. CMR detected LGE in the inferior (4/11), the inferolateral (5/11), the inferoseptal (2/11), the anterior (3/11), apical (3/11) and in the lateral segments (2/11). In addition, in all but two patients, these segments matched ECG abnormalities in corresponding leads. CMR identified microvascular obstruction in 4/11 (36 %) patients. Patients with clinical, ECG, and biochemical signs of acute MI but unobstructed coronary arteries may have CMR-detectable myocardial scars. Information on myocardial scarring may help to make the diagnosis and draw therapeutic consequences. This case series underlines the value of contrast-enhanced CMR for myocardial tissue characterization.

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Title: Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries
Authors: Jeannine A. J. M. Hermens
Jan van Es
Clemens von Birgelen
Jeroen W. op den Akker
Lodewijk J. Wagenaar
Publication date: 01-08-2014
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 6/2014
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-014-0435-7

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Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries

Abstract

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Abstract

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