Document Detail


The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries.
MedLine Citation:
PMID:  17478458     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Troponin measurement is used in the assessment and risk stratification of patients presenting acutely with chest pain when the main cause of elevation is coronary artery disease. However, some patients have no coronary obstruction on angiography, leading to diagnostic uncertainty. We evaluated the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in these patients. METHODS AND RESULTS: Sixty consecutive patients (mean age 44 years, 72% male) with a troponin-positive episode of chest pain and unobstructed coronary arteries were recruited within 3 months of initial presentation. All patients underwent CMR with cine imaging, T2-weighted imaging for detection of inflammation, and late gadolinium enhancement imaging for detection of infarction/fibrosis. An identifiable basis for troponin elevation was established in 65% of patients. The commonest underlying cause was myocarditis (50%), followed by myocardial infarction (11.6%) and cardiomyopathy (3.4%). In the 35% of patients where no clear diagnosis was identified by CMR, significant myocardial infarction/fibrosis was excluded. CONCLUSION: CMR is a valuable adjunct to conventional investigations in a diagnostically challenging and important group of patients with troponin-positive chest pain and unobstructed coronary arteries.
Authors:
Ravi G Assomull; Jonathan C Lyne; Niall Keenan; Ankur Gulati; Nicholas H Bunce; Simon W Davies; Dudley J Pennell; Sanjay K Prasad
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-05-03
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-21     Completed Date:  2007-12-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1242-9     Citation Subset:  IM    
Affiliation:
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London SW3 6NP, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Biological Markers / blood
Cardiomyopathy, Dilated / complications,  diagnosis
Chest Pain / etiology*
Contrast Media
Female
Gadolinium DTPA / diagnostic use
Heart Diseases / complications,  diagnosis*
Humans
Image Enhancement / methods
London
Magnetic Resonance Imaging, Cine / methods
Male
Middle Aged
Myocardial Infarction / complications
Myocarditis / complications,  diagnosis
Prospective Studies
Takotsubo Cardiomyopathy / complications,  diagnosis
Troponin / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Contrast Media; 0/Troponin; 80529-93-7/Gadolinium DTPA
Comments/Corrections
Comment In:
Eur Heart J. 2007 May;28(10):1175-7   [PMID:  17395680 ]
Eur Heart J. 2007 Oct;28(19):2416-7; author reply 2417   [PMID:  17785397 ]

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