Author + information
- Adam N. Mather, MBBS,
- Timothy A. Fairbairn, MBChB,
- Nigel J. Artis, MBChB,
- John P. Greenwood, PhD and
- Sven Plein, PhD⁎ ()
- ↵⁎Address for correspondence:
Dr. Sven Plein, Division of Cardiovascular and Neuronal Remodelling, University of Leeds, G-floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom
the universal definition of myocardial infarction requires an elevated troponin value exceeding the 99th percentile of the upper reference limit (URL) together with at least 1 of the following: symptoms of ischemia; electrocardiogram (ECG) changes of new ischemia; development of pathological Q-waves on the ECG; or imaging evidence of new loss of viable myocardium and new regional wall motion abnormality (1). While troponin is sensitive and specific for myocardial necrosis it does not diagnose the mechanism of damage. Frequently, patients with ischemic symptoms, ECG changes, and elevated troponin are referred for invasive coronary angiography. In a small but significant subgroup of these patients, coronary angiography may be normal or demonstrate only minor, non–flow-limiting atheroma. Establishing the correct diagnosis is important to ensure that these patients receive the appropriate treatment and risk management (2). There may also be further implications regarding life insurance.
Cardiac magnetic resonance (CMR) imaging has the unique ability to characterize various pathophysiological effects of acute myocardial injury. In this article, we present 6 cases (Figs. 1–6)⇓⇓⇓⇓⇓ which demonstrate the diagnostic value of multiparametric CMR assessment in the differential diagnosis of ischemic symptoms with raised biomarkers but unobstructed coronary arteries. Biochemical analysis of troponin I (TnI) (Accu TnI assay, Beckman Coulter, Brea, California) demonstrated interassay coefficient of variance of 10% at 0.06 μg/l and the 99th percentile value of 0.04 μg/l.
Dr. Sven Plein is supported by a Wellcome Trust fellowship (WT078288).
- American College of Cardiology Foundation
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