Published online Jun 26, 2020. doi: 10.4330/wjc.v12.i6.248
Peer-review started: February 28, 2020
First decision: April 29, 2020
Revised: May 13, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: June 26, 2020
Processing time: 119 Days and 9.6 Hours
The diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) necessitates documentation of an acute myocardial infarction (AMI), non-obstructive coronary arteries, using invasive coronary angiography or coronary computed tomography angiography and no clinically overt cause for AMI. Historically patients with MINOCA represent a clinical dilemma with subsequent uncertain clinical management. Differential diagnosis is crucial to choose the best therapeutic option for ischemic and non-ischemic MINOCA patients. Cardiovascular magnetic resonance (CMR) is able to analyze cardiac structure and function simultaneously and provides tissue characterization. Moreover, CMR could identify the cause of MINOCA in nearly two-third of patients providing valuable information for clinical decision making. Finally, it allows stratification of patients with worse outcomes which resulted in therapeutic changes in almost half of the patients. In this review we discuss the features of CMR in MINOCA; from exam protocols to imaging findings.
Core tip: Cardiovascular magnetic resonance (CMR) plays a key role in myocardial infarction with non-obstructive coronary arteries (MINOCA) patients. A CMR study protocol to evaluate MINOCA patients should include evaluation of cardiac structure and function and tissue characterization with evaluation myocardial injury. With this approach CMR could identify the cause of MINOCA in nearly two-third of patients (acute myocardial infarction, acute myocarditis, takotsubo syndrome and other causes) providing valuable information for clinical decision making and allows stratification of patients with worse outcome.