Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging

• Published in: Archives of cardiovascular diseases Vol. 104; no. 10; pp. 509 - 517
• Main Authors: Chopard, Romain, Jehl, Jerome, Dutheil, Johanna, Genon, Vincent Descotes, Seronde, Marie-France, Kastler, Bruno, Schiele, Francois, Meneveau, Nicolas
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Masson SAS 01.10.2011; Elsevier
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Adult; Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiac magnetic resonance imaging; Cardiology. Vascular system; Cardiovascular; Chi-Square Distribution; Coronary Angiography; Coronary heart disease; Diagnosis, Differential; Disease Progression; Evolution; Female; Heart; Humans; Internal Medicine; IRM cardiaque; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardite; Myocarditis; Myocarditis - blood; Myocarditis - diagnosis; Myocarditis. Cardiomyopathies; Predictive Value of Tests; Prognosis; Prospective Studies; Syndrome coronaire aigu; Syndrome de Tako-tsubo; Tako-tsubo cardiomyopathy; Takotsubo Cardiomyopathy - blood; Takotsubo Cardiomyopathy - diagnosis; Time Factors; Troponin I - blood; Up-Regulation; Évolution; cTnI; TTC; TTE; LVESI; left ventricular end-systolic volume index; LVEF; LV; Syndrome coronaire aigu; Syndrome de Tako-tsubo; left ventricular ejection fraction; cardiac troponin I; Myocardite; electrocardiogram; Évolution; LVEDI; IRM cardiaque; Evolution; left ventricular; pulmonary embolism; AMI; Tako-tsubo cardiomyopathy; ECG; transthoracic echocardiography; LGE; left ventricular end-diastolic volume index; Myocarditis; ACS; PE; late gadolinium enhancement; Acute coronary syndrome; Cardiac magnetic resonance imaging; acute myocardial infarction; CMRI; Heart; Coronary artery; Medical imagery; Cardiovascular disease; Cardiology; Normal; Coronary heart disease; Myocardial disease; Nuclear magnetic resonance imaging
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2011.05.004

Summary Background Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). Data are sparse regarding the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI. Aims To evaluate the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI, with a 1-year follow-up. Methods Eighty-seven consecutive patients (mean age, 53 years; 40.2% men) presenting an ACS with troponin elevation and normal coronary arteries by angiography were prospectively included. All patients underwent CMRI at 3-Tesla. Adverse events were recorded with 1-year follow-up. Results A likely aetiology for the acute clinical presentation was established by CMRI in 63.2% of patients (22.7% MI, 26.4% acute myocarditis, 11.5% TTC). During follow-up, one patient in the MI group had a stroke (1.2%). In the myocarditis group, there was one initial cardiogenic shock, one episode of congestive heart failure (1.2%) and nine patients had recurrent chest pain without troponin elevation (10.3%). Two TTC group patients initially presented with cardiogenic shock (2.4%); there were no other adverse events in this group during follow-up. In the remaining 36.7% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up. Conclusion CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution.