Published online Jun 28, 2017. doi: 10.4329/wjr.v9.i6.280
Peer-review started: January 7, 2017
First decision: February 17, 2017
Revised: May 9, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: June 28, 2017
Processing time: 166 Days and 20.2 Hours
To define the role of cardiac magnetic resonance (CMR) by analyzing a particular group of patients with suspected acute coronary syndrome (ACS) and normal coronary angiogram.
From January 2009 to December 2015, we examined 220 patients with clinical suspicion of ACS, Troponin elevation [the threshold used to define a positive Troponin T test (TnT) was 0.1 ng/mL] and no significant coronary disease at angiography (the patients were considered to have significant angiographic disease only a 50% stenosis was detected in any of their coronary arteries). The role of CMR with the late gadolinium enhancement was evaluated.
CMR was performed to 190 patients (86%) of this group which reveals: Myocarditis in 90 patients (47%); apical ballooning (Tako-Tsubo syndrome) in 32 patients (17%); myocardial infarction (MI) in 40 patients (21%) and no clear diagnosis identified by CMR in 28 patients (15%). A comparison with previous studies was also made. Clinical and echocardiographic follow-ups were performed at 12 ± 2 mo and no major adverse cardiac events were revealed.
There is a group of patients with clinical suspicion of ACS displaying normal coronary angiograms. CMR was demonstrated to be a valuable tool in the differential diagnosis evaluation of myocarditis, apical ballooning and MI.
Core tip: In some patients with suspected acute coronary syndrome and elevated Troponin, the subsequent coronary angiography reveals normal coronaries. These patients represent an obscure and difficult field of diagnosis and investigation. There are several potential causes of this uncertainty, such as myocardial infarction with a recanalized coronary artery, myocarditis, different cardiomyopathies, and other rare conditions. Cardiac magnetic resonance offers a new and more appropriate method in distinguishing between different chest pain etiologies.