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Original research
Early cardiac magnetic resonance imaging in troponin-positive acute chest pain and non-obstructed coronary arteries
  1. Hajnalka Vágó1,
  2. Liliána Szabó1,
  3. Zsófia Dohy1,
  4. Csilla Czimbalmos1,
  5. Attila Tóth1,
  6. Ferenc Imre Suhai1,
  7. György Bárczi1,
  8. V. Anna Gyarmathy2,3,
  9. Dávid Becker1,
  10. Béla Merkely1
  1. 1 Heart and Vascular Center, Semmelweis University, Budapest, Hungary
  2. 2 EpiConsult LLC, Dover, Delaware, USA
  3. 3 Johns Hopkins, Baltimore, Maryland, USA
  1. Correspondence to Dr Hajnalka Vágó, Heart and Vascular Center, Semmelweis University, Budapest 1085, Hungary; vagoha{at}


Objective We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries.

Methods In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out.

Results CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality.

Conclusions CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.

  • cardiac magnetic resonance (CMR) imaging
  • acute myocardial infarction
  • myocarditis

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  • HV and LS are joint first authors.

  • DB and BM are joint senior authors.

  • Twitter @liliana_e_szabo

  • HV and LS contributed equally.

  • DB and BM contributed equally.

  • Contributors HV and LS: involved in data collection, study design, manuscript preparation and statistical analysis. ZD, CC, AT, FIS and GB: involved in data collection and manuscript review. VAG: involved in statistical support and manuscript preparation. DB and BM: involved in study design and manuscript review.

  • Funding This study was supported by the National Research, Development and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Programme). This research was financed by the Higher Education Institutional Excellence Programme of the Ministry for Innovation and Technology in Hungary within the framework of the Therapeutic Development Thematic Programme of Semmelweis University.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the Hungarian National Institute of Pharmacy and Nutrition (OGYEI/29206-4/2019) in correspondence with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Please contact the corresponding author.

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