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Education in Heart
Imaging patients with myocardial infarction with non-obstructive coronary arteries (MINOCA)
  1. Isabella Leo1,
  2. Giandomenico Bisaccia2,3,
  3. Nikolaos Miaris2,
  4. Maria Cristina Procopio2,4,
  5. Roberto Licordari2,5,
  6. Chiara Bucciarelli-Ducci2
  1. 1 Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
  2. 2 Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3 Department of Neuroscience, Imaging and Clinical Sciences, “G d’Annunzio” University of Chieti-Pescara, Chieti, Italy
  4. 4 Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
  5. 5 Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy
  1. Correspondence to Dr Chiara Bucciarelli-Ducci, Guy's and St Thomas' NHS Foundation Trust, London UB9 6JH, UK; c.bucciarelli-ducci{at}rbht.nhs.uk

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) defines a heterogeneous group of atherosclerotic and non-atherosclerotic conditions, causing myocardial injury in the absence of obstructive coronary artery disease. Unveiling the mechanisms subtended to the acute event is often challenging; a multimodality imaging approach is helpful to aid the diagnosis. Invasive coronary imaging with intravascular ultrasound or optical coherence tomography should be used, when available, during index angiography to detect plaque disruption or spontaneous coronary artery dissection. Cardiovascular magnetic resonance has instead a key role among the non-invasive modalities, allowing the differentiation between MINOCA and its non-ischaemic mimics and providing prognostic information. This educational paper will provide a comprehensive review of the strengths and limitations of each imaging modality in the evaluation of patients with a working diagnosis of MINOCA.

  • myocardial infarction
  • cardiac imaging techniques
  • Magnetic Resonance Imaging
  • coronary angiography

https://doi.org/10.1136/heartjnl-2023-322835

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    Footnotes

    • Twitter @giandomd, @chiarabd

    • Contributors IL: manuscript draft. GB, NM, MCP, RL: manuscript writing contribution. CB-D: critical revision and final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CB-D is the chief executive officer (part-time) for the Society for Cardiovascular Magnetic Resonance. She has received speakers fees from Circle Cardiovascular Imaging, Bayer and Siemens Healthineers.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Author note References which include a * are considered to be key references.