Troponin positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI

Mahmoudi, Michael, Harden, S., Abid, N., Peebles, C., Nicholas, Z., Jones, T., McKenzie, D. and Curzen, N. (2012) Troponin positive chest pain with unobstructed coronary arteries: definitive differential diagnosis using cardiac MRI. British Journal of Radiology. (doi:10.1259/bjr/90663866). (PMID:22457316)

Abstract

Objective: The purpose of this study was to assess the outcome of cardiac MRI (CMRI)with late gadolinium enhancement (LGE) at outpatient follow-up in a consecutive
series of patients with troponin-positive chest pain but unobstructed coronary arteries at the index admission.

Methods: The study comprised 91 consecutive patients who presented to our institution with cardiac chest pain, elevated troponin I and unobstructed coronary
arteries on coronary angiography. All patients underwent an outpatient CMRI with LGE imaging in order to establish a definitive diagnosis.

Results: The average time from coronary angiography to LGE-CMRI was 2 months.73% of patients had no abnormality on their LGE-CMRI, 16% of patients had patchy late enhancement consistent with myocarditis and 11% had focal subendocardial or full thickness late enhancement consistent with myocardial infarction. There were no
deaths in this cohort during a mean follow-up of 21 months.

Conclusion: LGE-CMRI is a useful tool for establishing whether such patients have definitive evidence of non-ST-segment elevation myocardial infarction (NSTEMI), and
can make an important contribution to the long-term management strategy of these patients as an inappropriate diagnosis of NSTEMI carries important medical, social and
financial implications.

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Contributors

Author: Michael Mahmoudi

Author: N. Curzen

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