Soins Intensifs Cardiologiques-Plateau de Cardiologie Interventionnelle, CHU de Bordeaux, Hopital Haut-Lévêque, 5 Avenue de Magellan, 33604, Pessac, France.
Int J Cardiovasc Imaging. 2012 Apr;28(4):783-94. doi: 10.1007/s10554-011-9879-1. Epub 2011 May 3.
To evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance (CMR) in patients with chest pain, raised troponin and unobstructed coronary arteries, and to compare subsequent event rates between diagnostic groups. 130 patients (mean age: 54 ± 17) presenting with troponin-positive acute chest pain and unobstructed coronary arteries were included. All patients were managed according to European Society of Cardiology guidelines, including echocardiography, and had CMR within 6.2 ± 5.3 days of presentation. During follow-up, major adverse cardiovascular events (MACE) were recorded. CMR provided a diagnosis in 100 of 130 patients (76.9%), with the remaining 30 (23.1%) having a normal examination. CMR diagnosed 37 (28.5%) acute myocardial infarctions, 34 (26.1%) myocarditis, 28 (21.5%) apical ballooning syndromes and 1 (0.8%) hypertrophic cardiomyopathy. When a single diagnosis was suspected by the referring physician, CMR validated this diagnosis in 32 patients (76.2%). CMR provided a formal diagnosis in 61 patients (69.3%) in which the clinical diagnosis was uncertain between at least two possibilities. CMR corrected a wrong diagnosis in 10 patients (7.7%). CMR-suggested diagnosis led to a modification of therapy in 42 patients (32.3%). Median follow-up was 34 months (interquartile range 24-49) in 124 patients. Sixteen patients (12.9%) experienced MACE. MACE rate was not different between patients with a conclusive CMR and normal CMR. In patients with acute troponin-positive chest pain and unobstructed coronary arteries, early CMR has important diagnostic and therapeutic implications. However its association with occurrence of MACE during mid term follow-up was not obvious.
为了评估心脏磁共振（CMR）在胸痛、肌钙蛋白升高和冠状动脉无阻塞的患者中的增量诊断和预后价值，并比较不同诊断组的后续事件发生率。纳入了 130 名胸痛、肌钙蛋白升高和冠状动脉无阻塞的患者（平均年龄：54 ± 17 岁）。所有患者均按照欧洲心脏病学会指南进行管理，包括超声心动图检查，并在就诊后 6.2 ± 5.3 天内进行 CMR 检查。在随访期间，记录主要不良心血管事件（MACE）。130 名患者中有 100 名（76.9%）得到了 CMR 诊断，其余 30 名（23.1%）的 CMR 检查正常。CMR 诊断出 37 例（28.5%）急性心肌梗死、34 例（26.1%）心肌炎、28 例（21.5%）心尖球囊综合征和 1 例（0.8%）肥厚型心肌病。当参考医师怀疑存在单一诊断时，CMR 在 32 名患者（76.2%）中验证了该诊断。CMR 在 61 名（69.3%）临床诊断不确定至少有两种可能性的患者中提供了正式诊断。CMR 纠正了 10 名（7.7%）错误的诊断。CMR 建议的诊断导致 42 名（32.3%）患者的治疗方案发生改变。124 名患者的中位随访时间为 34 个月（四分位距 24-49）。16 名患者（12.9%）发生了 MACE。有明确 CMR 和正常 CMR 的患者的 MACE 发生率没有差异。在胸痛、肌钙蛋白升高和冠状动脉无阻塞的急性患者中，早期 CMR 具有重要的诊断和治疗意义。然而，其与中期随访期间 MACE 发生的相关性并不明显。
