PMID- 24794293 OWN - NLM STAT- MEDLINE DCOM- 20160328 LR - 20211021 IS - 1875-8312 (Electronic) IS - 1569-5794 (Linking) VI - 30 IP - 6 DP - 2014 Aug TI - Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries. PG - 1097-103 LID - 10.1007/s10554-014-0435-7 [doi] AB - Patients with acute chest pain, electrocardiographic ST-elevation and significant elevation of cardiac troponin but without obstructive coronary artery disease represent a diagnostic and therapeutic dilemma. Cardiac magnetic resonance imaging (CMR) can elucidate underlying alternative causes of troponin elevation including detection of (minor) myocardial infarction (MI) by identifying myocardial scarring as delayed enhancement. Of 77 patients, who were admitted between March 2009 and December 2012 with electrocardiographic (ECG) and biochemical evidence of acute MI without obstructive coronary artery disease, 45 patients underwent CMR that showed in 11/77 (14%) late gadolinium enhancement (LGE), compatible with myocardial scarring. We analyzed clinical, echocardiographic, and CMR data of these patients. Elevated troponin I levels were observed in all patients (median 1.3 ng/l, IQR 0.44-187) with median peak creatinine phosphokinase of 485 U/l (IQR 234-618). Echocardiographic wall motion abnormalities were detected in 8/11 (73%) patients; in 75% of these segments, ECG abnormalities were observed in corresponding leads. CMR detected LGE in the inferior (4/11), the inferolateral (5/11), the inferoseptal (2/11), the anterior (3/11), apical (3/11) and in the lateral segments (2/11). In addition, in all but two patients, these segments matched ECG abnormalities in corresponding leads. CMR identified microvascular obstruction in 4/11 (36%) patients. Patients with clinical, ECG, and biochemical signs of acute MI but unobstructed coronary arteries may have CMR-detectable myocardial scars. Information on myocardial scarring may help to make the diagnosis and draw therapeutic consequences. This case series underlines the value of contrast-enhanced CMR for myocardial tissue characterization. FAU - Hermens, Jeannine A J M AU - Hermens JA AD - Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands, J.Hermens@mst.nl. FAU - van Es, Jan AU - van Es J FAU - von Birgelen, Clemens AU - von Birgelen C FAU - Op den Akker, Jeroen W AU - Op den Akker JW FAU - Wagenaar, Lodewijk J AU - Wagenaar LJ LA - eng PT - Journal Article DEP - 20140503 PL - United States TA - Int J Cardiovasc Imaging JT - The international journal of cardiovascular imaging JID - 100969716 RN - 0 (Biomarkers) RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 0 (Troponin I) RN - 6HG8UB2MUY (Meglumine) RN - EC 2.7.3.2 (Creatine Kinase) RN - L0ND3981AG (gadoterate meglumine) SB - IM MH - Adult MH - Aged, 80 and over MH - Biomarkers/blood MH - Cicatrix/blood/*diagnosis/pathology/physiopathology MH - Contrast Media MH - Coronary Artery Disease/blood/*diagnosis/pathology/physiopathology MH - *Coronary Circulation MH - Creatine Kinase/blood MH - Electrocardiography MH - Female MH - Humans MH - *Magnetic Resonance Imaging MH - Male MH - Meglumine MH - *Microcirculation MH - Middle Aged MH - Myocardial Infarction/blood/*diagnosis/pathology/physiopathology MH - Myocardium/metabolism/*pathology MH - Organometallic Compounds MH - Predictive Value of Tests MH - Retrospective Studies MH - Troponin I/blood MH - Up-Regulation EDAT- 2014/05/06 06:00 MHDA- 2016/03/29 06:00 CRDT- 2014/05/06 06:00 PHST- 2014/01/15 00:00 [received] PHST- 2014/04/26 00:00 [accepted] PHST- 2014/05/06 06:00 [entrez] PHST- 2014/05/06 06:00 [pubmed] PHST- 2016/03/29 06:00 [medline] AID - 10.1007/s10554-014-0435-7 [doi] PST - ppublish SO - Int J Cardiovasc Imaging. 2014 Aug;30(6):1097-103. doi: 10.1007/s10554-014-0435-7. Epub 2014 May 3.