Skip to main content
  • Oral presentation
  • Open access
  • Published:

Suspected acute coronary syndrome with normal coronary arteries: cardiovascular magnetic resonance in the diagnosis and management in the emergency room

Background

Acute chest pain, ST-changes on EKG and elevation of cardiac troponin in patients without obstructive coronary artery disease represent a clinical challenge. Cardiovascular magnetic resonance (CMR) can be used to diagnose causes other than obstructive coronary artery disease.The aim of this study was to evaluate the usefulness of CMRto diagnoseconditions in the emergency room that otherwise would be consideredas acute coronary syndrome (ACS) in patients with normal coronary arteries.

Methods

Forty-seven patients with chest pain and/or electrocardiographic changes and elevated troponin concentration occurring in the absence of significant coronary artery stenosis (normal or stenosis < 50% of the vessel diameter on angiography, computed tomography or both) were selected and prospectively submitted to CMR exam in a 1.5T Philips scanner between May 2013 and June 2014. Ventricular function by cine MR with SSFP technique, and myocardial tissue characterization using late gadolinium enhancement (LGE) were evaluated in patients referred to the Emergency room. LGE patterns were analyzed visually by 2 observers and classified as ischemic (involving subendocardial layer) and non-ischemic (multifocal, not involving subendocardial layer, non coronary distribution).

Results

Among 47 patients, all with interpretableCMR exams, diagnosis of acute myocarditis was found in 21 patients (45%), acute myocardial infarction in 9 patients (19%) and Takotsubo cardiomyopathy in 4 patients (9%). Other final diagnoses were hypertrophic cardiomyopathy (7%), coronary embolism (4%), cardiomyopathy (4%), sepsis (2%), aortic stenosis (2%) and noncompaction myocardium (2%). In 34 patients (72%), CMR changed theinitial ACS diagnosis to another final diagnosis. Additionally,2 patients (5%) primarily considered as having myocarditis received a final diagnosis of myocardial infarction.

Conclusions

In the study, 77% of patients had theirprimary diagnosis and treatment changed after CMR study. The presence, distribution and pattern of late gadolinium enhancement by CMR were crucial in establishing a precise final diagnosis and appropriately changing patient management.

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakamura, D.Y., Reiser, C.S., Villanueva, A. et al. Suspected acute coronary syndrome with normal coronary arteries: cardiovascular magnetic resonance in the diagnosis and management in the emergency room. J Cardiovasc Magn Reson 17 (Suppl 1), O49 (2015). https://doi.org/10.1186/1532-429X-17-S1-O49

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/1532-429X-17-S1-O49

Keywords