Bristol Medical School, Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK.
Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Trust, Upper Maudlin Street, Bristol, BS2 8HY, UK.
Eur Heart J Cardiovasc Imaging. 2023 Dec 21;25(1):8-15. doi: 10.1093/ehjci/jead182.
In ∼5-15% of all cases of acute coronary syndromes (ACS) have unobstructed coronaries on angiography. Cardiac magnetic resonance (CMR) has proven useful to identify in most patients the underlying diagnosis associated with this presentation. However, the role of CMR to reclassify patients from the initial suspected condition has not been clarified. The aim of this study was to assess the proportion of patients with suspected MINOCA, or non-MINOCA, that CMR reclassifies with an alternative diagnosis from the original clinical suspicion.
A retrospective cohort of patients in a tertiary cardiology centre was identified from a registry database. Patients who were referred for CMR for investigation of suspected MINOCA, and a diagnosis pre- and post-CMR was recorded to determine the proportion of diagnoses reclassified. A total of 888 patients were identified in the registry. CMR reclassified diagnosis in 78% of patients. Diagnosis of MINOCA was confirmed in only 243 patients (27%), whilst most patients had an alternative diagnosis (73%): myocarditis n = 217 (24%), Takotsubo syndrome n = 115 (13%), cardiomyopathies n = 97 (11%), and normal CMR/non-specific n = 216 (24%).
In a large single-centre cohort of patients presenting with ACS and unobstructed coronary arteries, most patients had a non-MINOCA diagnosis (73%) (myocarditis, Takotsubo, cardiomyopathies, or normal CMR/non-specific findings), whilst only a minority had confirmed MINOCA (27%). Performing CMR led to reclassifying patients' diagnosis in 78% of cases, thus confirming its important clinical role and underscoring the clinical challenge in diagnosing MINOCA and non MINOCA conditions.
在所有急性冠状动脉综合征（ACS）病例中，约有 5-15%的患者在血管造影时冠状动脉无阻塞。心脏磁共振（CMR）已被证明可用于确定大多数患者与该表现相关的潜在诊断。然而，CMR 重新分类最初怀疑的疾病的作用尚未阐明。本研究旨在评估疑似 MINOCA 或非 MINOCA 的患者中，CMR 重新分类为初始临床怀疑的替代诊断的比例。
从一个注册数据库中确定了一个三级心脏病中心的回顾性队列。记录了因疑似 MINOCA 而接受 CMR 检查的患者，并记录了 CMR 前后的诊断，以确定诊断重新分类的比例。在注册中确定了 888 名患者。CMR 重新分类了 78%的患者的诊断。仅在 243 名患者（27%）中证实了 MINOCA 诊断，而大多数患者有替代诊断（73%）：心肌炎 n = 217（24%），Takotsubo 综合征 n = 115（13%），心肌病 n = 97（11%），以及正常 CMR/非特异性 n = 216（24%）。
在 ACS 且冠状动脉无阻塞的大型单中心队列中，大多数患者（73%）的诊断为非 MINOCA（心肌炎、Takotsubo、心肌病或正常 CMR/非特异性发现），而仅有少数患者（27%）确诊为 MINOCA。CMR 的实施使 78%的患者的诊断重新分类，从而证实了其重要的临床作用，并强调了诊断 MINOCA 和非 MINOCA 疾病的临床挑战。
