Author + information
- Received July 8, 2019
- Revision received November 20, 2019
- Accepted November 22, 2019
- Published online May 4, 2020.
- Pierre-Francois Lintingre, MDa,
- Hubert Nivet, MDa,
- Stéphanie Clément-Guinaudeau, MD, MSca,
- Claudia Camaioni, MDa,
- Soumaya Sridi, MDa,
- Olivier Corneloup, MDa,
- Edouard Gerbaud, MDb,
- Pierre Coste, MDb,
- Gael Dournes, MD, PhDa,
- Valérie Latrabe, MDa,
- Francois Laurent, MDa,c,
- Michel Montaudon, MD, PhDa,c and
- Hubert Cochet, MD, PhDa,c,∗ ()
- aDepartment of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- bCardiology Intensive Care Unit, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- cIHU LIRYC, Université de Bordeaux-Inserm U1045, Pessac, France
- ↵∗Address for correspondence:
Prof. Hubert Cochet, Unité d’Imagerie Thoracique et Cardiovasculaire, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France.
Objectives The aim of this study was to assess the diagnostic yield of cardiac magnetic resonance (CMR) including high-resolution (HR) late gadolinium enhancement (LGE) imaging using a 3-dimensional respiratory-navigated method in patients with myocardial infarction with nonobstructed coronary arteries (MINOCA).
Background CMR plays a pivotal role for the diagnosis of patients with MINOCA. However, the diagnosis remains inconclusive in a significant number of patients, the results of CMR being either negative or uncertain (i.e., compatible with multiple diagnoses).
Methods Consecutive patients categorized as having MINOCA after blood testing, electrocardiography, coronary angiography, and echocardiography underwent conventional CMR, including cine, T2-weighted, first-pass perfusion, and conventional breath-held LGE imaging. HR LGE imaging using a free-breathing method allowing improved spatial resolution (voxel size 1.25 × 1.25 × 2.5 mm) was added to the protocol when the results of conventional CMR were inconclusive and was optional otherwise. Diagnoses retained after reviewing conventional CMR were compared with those retained after the addition of HR LGE imaging.
Results From 2013 to 2016, 229 patients were included (mean age 56 ± 17 years, 45% women). HR LGE imaging was performed in 172 patients (75%). In this subpopulation, definite diagnoses were retained after conventional CMR in 86 patients (50%): infarction in 39 (23%), myocarditis in 32 (19%), takotsubo cardiomyopathy in 13 (8%), and other diagnoses in 2 (1%). In the remaining 86 patients (50%), results of CMR were inconclusive: negative in 54 (31%) and consistent with multiple diagnoses in 32 (19%). HR LGE imaging led to changes in final diagnosis in 45 patients (26%) and to a lower rate of inconclusive final diagnosis (29%) (p < 0.001). In particular, HR LGE imaging could reveal or ascertain the diagnosis of infarction in 14% and rule out the diagnosis of infarction in 12%. HR LGE imaging was particularly useful when the results of transthoracic echocardiography, ventriculography, and conventional CMR were negative, with a 48% rate of modified diagnosis in this subpopulation.
Conclusions HR LGE imaging has high diagnostic value in patients with MINOCA and inconclusive findings on conventional CMR. This has major diagnostic, prognostic, and therapeutic implications.
- cardiac magnetic resonance
- late gadolinium enhancement
- myocardial infarction with nonobstructed coronary arteries
The research leading to these results has received funding from l’Agence Nationale de la Recherche under grant agreements Equipex MUSIC ANR-11-EQPX-0030 and LIRYC ANR-10-IAHU-04 and from the European Research Council under grant agreement ERC 715093. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received July 8, 2019.
- Revision received November 20, 2019.
- Accepted November 22, 2019.
- 2020 The Authors