Yang Kai, Zhao Shi-Hua
Magnetic Resonance Imaging Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No.167, Xicheng District, Beijing 100037, China.
Radiol Case Rep. 2022 Jul 21;17(9):3399-3404. doi: 10.1016/j.radcr.2022.06.101. eCollection 2022 Sep.
Myocardial infarction with nonobstructive coronary artery (MINOCA) is a common condition in clinical practice with multiple specific causes, such as plaque rupture, plaque erosion, and epicardial coronary vasospasm. There must be an ischemic mechanism responsible for the myocyte injury and an exclusion of nonischemic mechanisms that can mimic myocardial infarction, and then a diagnosis of MINOCA can be made. Cardiac magnetic resonance (CMR) plays an essential role in the diagnosis and differential diagnosis of MINOCA, which cannot only exclude myocarditis, Takotsubo syndrome, and cardiomyopathies, but also provide imaging confirmation of acute myocardial infarction. In this study, we presented 2 typical cases with the clinical presentation of acute myocardial infarction but normal or nonobstructive epicardial coronary arteries. Further CMR examinations showed different patterns of late gadolinium enhancement (LGE) in these 2 cases, one case with subendocardial LGE of the anterolateral wall and the other one with subepicardial LGE of the lateral wall, which indicated 2 different mechanisms for the myocyte injury. Subsequently, these 2 patients received different treatment regimens and were discharged with improved symptoms. In conclusion, CMR should be a mandatory test in patients with suspected MINOCA, because it can not only make a clear diagnosis, but also play an important role in guiding clinical decision-making.
非阻塞性冠状动脉心肌梗死（MINOCA）是临床实践中的常见病症，有多种特定病因，如斑块破裂、斑块侵蚀和心外膜冠状动脉痉挛。必须存在导致心肌细胞损伤的缺血机制，并排除可模拟心肌梗死的非缺血机制，才能做出MINOCA的诊断。心脏磁共振成像（CMR）在MINOCA的诊断和鉴别诊断中起着至关重要的作用，它不仅可以排除心肌炎、Takotsubo综合征和心肌病，还能提供急性心肌梗死的影像学证据。在本研究中，我们展示了2例临床表现为急性心肌梗死但心外膜冠状动脉正常或无阻塞的典型病例。进一步的CMR检查显示这2例病例有不同的延迟钆增强（LGE）模式，1例为前侧壁心内膜下LGE，另1例为侧壁心外膜下LGE，这表明心肌细胞损伤有2种不同机制。随后，这2例患者接受了不同的治疗方案，出院时症状有所改善。总之，CMR对于疑似MINOCA的患者应是一项必需的检查，因为它不仅能明确诊断，还在指导临床决策中发挥重要作用。
