Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries
Cardiac MR enables diagnosis in 90% of patients with acute chest pain, elevated biomarkers and unobstructed coronary arteries
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DOI：
10.1259/bjr.20150025
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发表时间：
2015-01-01
影响因子：
2.6
通讯作者：
Kreitner, K-F
中科院分区：
文献类型：
--
作者：
Emrich, T.;Emrich, K.;Kreitner, K-F
目的：为了评估心脏MRI（CMR）在急性胸痛，心肌酶升高和阴性coronary angiograph.Methods：本研究包括了总共125例患者在胸痛单位在39个月的时间内治疗的诊断价值。每例入选患者均在心导管插入术后3天（中位数）内接受MRI检查。MRI方案包括电影、水肿敏感和晚期钆增强成像。参考标准是一个共识的诊断基础上的临床随访和所有的临床，实验室和影像学data.Results的概要：MRI显示了众多的诊断，包括缺血性心肌病（CM），扩张型CM，心肌炎，Takotsubo CM，高血压性心脏病，肥厚型CM，心脏淀粉样变性和非致密化CM。113/125例患者（90%）的MRI诊断与最终参考诊断相同，仅12/125例患者的两种诊断不同。在两名患者中，没有最终的诊断可以建立。结论：CMR进行早期症状发作后，揭示了广泛的疾病。CMR在90%的急性胸痛、心肌酶升高和冠状动脉造影阴性的患者中提供了正确的最终诊断。知识的进步：诊断急性冠状动脉综合征但冠状动脉通畅的患者仍然是心脏病学家的挑战。在导管插入术后早期进行的CMR仅用简单快速的检查方案就可以揭示广泛的疾病，并且基于MRI的诊断与最终参考诊断之间具有高度一致性。
Objective: To assess the diagnostic value of cardiac MRI (CMR) in patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram.Methods: This study included a total of 125 patients treated in the chest pain unit during a 39-month period. Each included patient underwent MRI within a median of 3 days after cardiac catheterization. The MRI protocol comprised cine, oedema-sensitive and late gadolinium-enhancement imaging. The standard of reference was a consensus diagnosis based on clinical follow-up and the synopsis of all clinical, laboratory and imaging data.Results: MRI revealed a multitude of diagnoses, including ischaemic cardiomyopathy (CM), dilated CM, myocarditis, Takotsubo CM, hypertensive heart disease, hypertrophic CM, cardiac amyloidosis and non-compaction CM. MRI-based diagnoses were the same as the final reference diagnoses in 113/125 patients (90%), with the two diagnoses differing in only 12/125 patients. In two patients, no final diagnosis could be established.Conclusion: CMR performed early after the onset of symptoms revealed a broad spectrum of diseases. CMR delivered a correct final diagnosis in 90% of patients with acute chest pain, elevated cardiac enzymes and a negative coronary angiogram.Advances in knowledge: Diagnosing patients with acute coronary syndrome but unobstructed coronary arteries remains a challenge for cardiologists. CMR performed early after catheterization reveals a broad spectrum of diseases with only a simple and quick examination protocol, and there is a high concordance between MRI-based diagnoses and final reference diagnoses.