PMID- 31954658 OWN - NLM STAT- MEDLINE DCOM- 20210105 LR - 20210105 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 13 IP - 5 DP - 2020 May TI - High-Resolution Late Gadolinium Enhancement Magnetic Resonance for the Diagnosis of Myocardial Infarction With Nonobstructed Coronary Arteries. PG - 1135-1148 LID - S1936-878X(19)31156-8 [pii] LID - 10.1016/j.jcmg.2019.11.020 [doi] AB - 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 x 1.25 x 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. CI - Copyright (c) 2020 The Authors. Published by Elsevier Inc. All rights reserved. FAU - Lintingre, Pierre-Francois AU - Lintingre PF AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Nivet, Hubert AU - Nivet H AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Clement-Guinaudeau, Stephanie AU - Clement-Guinaudeau S AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Camaioni, Claudia AU - Camaioni C AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Sridi, Soumaya AU - Sridi S AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Corneloup, Olivier AU - Corneloup O AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Gerbaud, Edouard AU - Gerbaud E AD - Cardiology Intensive Care Unit, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Coste, Pierre AU - Coste P AD - Cardiology Intensive Care Unit, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Dournes, Gael AU - Dournes G AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Latrabe, Valerie AU - Latrabe V AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France. FAU - Laurent, Francois AU - Laurent F AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France; IHU LIRYC, Universite de Bordeaux-Inserm U1045, Pessac, France. FAU - Montaudon, Michel AU - Montaudon M AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France; IHU LIRYC, Universite de Bordeaux-Inserm U1045, Pessac, France. FAU - Cochet, Hubert AU - Cochet H AD - Department of Cardiovascular Imaging, Hopital Cardiologique du Haut-Leveque, CHU de Bordeaux, Pessac, France; IHU LIRYC, Universite de Bordeaux-Inserm U1045, Pessac, France. Electronic address: hcochet@wanadoo.fr. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200115 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) SB - IM CIN - JACC Cardiovasc Imaging. 2020 May;13(5):1149-1151. PMID: 32061557 MH - Adult MH - Aged MH - Contrast Media/*administration & dosage MH - Female MH - Humans MH - *Magnetic Resonance Imaging, Cine MH - Male MH - Middle Aged MH - Myocardial Infarction/*diagnostic imaging MH - Predictive Value of Tests MH - Retrospective Studies OTO - NOTNLM OT - cardiac magnetic resonance OT - late gadolinium enhancement OT - myocardial infarction with nonobstructed coronary arteries EDAT- 2020/01/20 06:00 MHDA- 2021/01/06 06:00 CRDT- 2020/01/20 06:00 PHST- 2019/07/08 00:00 [received] PHST- 2019/11/20 00:00 [revised] PHST- 2019/11/22 00:00 [accepted] PHST- 2020/01/20 06:00 [pubmed] PHST- 2021/01/06 06:00 [medline] PHST- 2020/01/20 06:00 [entrez] AID - S1936-878X(19)31156-8 [pii] AID - 10.1016/j.jcmg.2019.11.020 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2020 May;13(5):1135-1148. doi: 10.1016/j.jcmg.2019.11.020. Epub 2020 Jan 15.