Mahrukh Qureshi MBBS,BSC, Abstract Co-Author: Nothing to Disclose

Ben Ariff FRCR, PhD, Abstract Co-Author: Nothing to Disclose

Tarun Mittal MD,FRCR, Abstract Co-Author: Nothing to Disclose

Rajat Chowdhury MBBCh, Presenter: Nothing to Disclose

Several disease processes can present as an acute coronary syndrome (ACS) – chest pain, EKG changes and a troponin elevation. Cardiac MRI (CMR) when combined with late gadolinium contrast enhancement imaging (LGE) is a highly sensitive test for the detection of cardiac abnormalities, including the identification of infarction, inflammation, and fibrosis. We sought to evaluate the utility of CMR in establishing a diagnosis in patients presenting with troponin positive ACS, but found to have non-obstructed coronary arteries on angiography.

One hundred and fourteen patients (67 males, mean age ± SD = 45±16 years and 46 females, mean age = 57± 15 years) who fulfilled the above criteria were retrospectively identified from PACS and electronic patient record systems. All studies were performed on 1.5 Tesla Siemens Avanto MR scanner using a standard cardiac imaging protocol including steady-state free precession cine imaging and T1 weighted inversion recovery gradient echo sequences 10 minutes after IV gadopentetate dimeglumine (0.2ml/kg).  

In order of prevalence: 33 patients (28.9%) had evidence of a myocarditis identified by mid and/ or sub-epicardial LGE. This was most common in the lateral and inferior wall of the left ventricle. 21 (18.4%) had myocardial infarction with subendocardial LGE, 3 of which were associated with left ventricular dysfunction. 13 (11.4%) had hypertrophic cardiomyopathy (HCM), 5 of which demonstrating LGE. Takotsubo cardiomyopathy was identified in 8 (7%) patients by the presence of apical ballooning on the initial ventriculogram but normal ventricular function and the absence of LGE on CMR. Diagnoses of other cardiomyopathies were made in 6 patients. Pericarditis was present in only 2 cases (1.8%). 26 (22.8%) had normal CMR appearances with no LGE.  

CMR with late contrast enhancement is helpful in delineating the alternative causes of chest pain in patients presenting with acute coronary syndrome with an elevated troponin but absent or non-obstructive coronary artery disease. Myocardial inflammation was the commonest cause. Myocardial infarction and hypertrophic cardiomyopathy were the next commonest diagnoses.  

Cardiac MRI is helpful in patients presenting with acute coronary syndromes but non-obstructed coronary arteries and raised enzymes to delineate alternative causes of chest pain.

Qureshi, M, Ariff, B, Mittal, T, Chowdhury, R, Role of MRI in Patients Presenting with Acute Coronary Syndrome but Non-obstructed Coronary Arteries.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006252.html