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127 Early Versus Late CMR in Troponin-Positive Chest Pain with Unobstructed Coronaries
  1. Priyanka Singhal1,
  2. Amardeep Ghosh Dastidar2,
  3. Jonathan C Rodrigues2,
  4. Nauman Ahmed2,
  5. Alberto Palazzuoli2,
  6. Mandie Townsend2,
  7. Angus Nightingale2,
  8. Tom Johnson2,
  9. Julian Strange2,
  10. Andreas Baumbach2,
  11. Chiara Bucciarelli-Ducci2
  1. 1University of Bristol
  2. 2NIHR Biomedical Research Unit, Bristol Heart Institute

Abstract

Background Acute coronary syndrome (ACS) is one of the leading causes of morbidity and mortality. Up to 15% of ACS patients are left with a diagnostic dilemma when no significant coronary obstruction is identified. In these patients, CMR can identify different underlying diagnoses including: myocarditis, myocardial infarction (MI) with spontaneous recanalisation/embolus or Tako-Tsubo cardiomyopathy. However, there are discrepancies in the literature on the diagnostic pick-up rate by CMR and patients are not consistently scanned in the same time window.

Aim To evaluate the diagnostic role of performing CMR “early” (< 2 weeks from presentation) versus “late” (>2 weeks from presentation) in patients with troponin positive ACS and unobstructed coronaries.

Methods In this retrospective observational study, performed at a large cardiothoracic tertiary centre in the South-West of England, data were collected on consecutive patients with troponin positive ACS and unobstructed coronaries, referred for a CMR (September 2011 to July 2014). CMR was performed on a 1.5T scanner (Avanto, Siemens) using a comprehensive protocol that included long- and short-axis cines, T2 weighted STIR and early and late gadolinium enhancement. Each scan was reported by a consultant with >10 yrs CMR experience.

Results 204 consecutive patients (mean age 55 yrs) were included in the analysis (51% males). The median time interval between presentation and CMR was 20 days (range 1–150 days).

An “early” CMR was performed in 96 patients (median 6 days and range 1–14 days) and 108 patients underwent a “late” CMR scan (median 41 days and range 15–150 days). Overall, CMR identified a diagnosis in 70% of patients, whilst the remaining 30% of patients were classified as normal/unknown diagnosis. An “early” CMR scan significantly improved the diagnostic pick-up rate compared to a “late” CMR scan: 82% vs 54% respectively (p < 0.0001). Myocarditis was the most common diagnosis in “early” CMR (34%) whereas reperfused MI in “late” CMR (26%).

Conclusion The diagnostic role of CMR is significantly improved when performed within 2 weeks of acute presentation of troponin positive ACS with unobstructed coronaries. “Early” CMR established a final diagnosis in 82% of a large cohort of patients. In patients with ACS and unobstructed coronary arteries, CMR should be offered within a specified time window, ideally <2 weeks from presentation, in order to increase its diagnostic role and guide appropriate patient management.

Abstract 127 Figure 1

Graph to show comparison of diagnosis made in early CMR versus late CMR

Abstract 127 Table 1

Demographics table

  • ACS with unobstructed coronaries
  • CMR
  • Myocarditis

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