The Role of Cardiac Magnetic Resonance in the Evaluation of Patients Presenting with Suspected or Confirmed Acute Coronary Syndrome

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Abstract

Cardiac magnetic resonance imaging (CMR) has an important emerging role in the evaluation and management of patients who present with symptoms concerning for acute coronary syndrome (ACS). This paper discusses the role of CMR in the emergency department setting, where CMR can aid in the early and accurate diagnosis of non-ST elevation ACS in low and intermediate risk patients. For those with confirmed myocardial infarction (MI), CMR provides comprehensive prognostic information and can readily diagnose structural complications related to MI. Furthermore, the pattern of late gadolinium enhancement (LGE) seen on CMR can help determine the etiology of cardiac injury in the subset of patients presenting with ACS who do not have obstructive coronary artery disease by angiography.

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Most cited references 61

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ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine.

Jeffrey Anderson, Cynthia Adams, Elliott M. Antman … (2007)

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Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction.

Ingo Eitel, Steffen Desch, Georg Fuernau … (2010)

The aim of the study was to determine the prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance (CMR) in reperfused ST-segment elevation myocardial infarction. In acute myocardial infarction, CMR can retrospectively detect the myocardium at risk and the irreversible injury. This allows for quantifying the extent of salvaged myocardium after reperfusion as a potential strong end point for clinical trials and outcome. We analyzed 208 consecutive ST-segment elevation myocardial infarction patients undergoing primary angioplasty or= median group (2.9% vs. 22.1%, p < 0.001). The stepwise Cox proportional hazards model revealed that the MSI was the strongest predictor of major adverse cardiovascular events at 6-month follow-up (p < 0.001). All prognostic clinical (symptom onset to reperfusion), angiographic (Thrombolysis In Myocardial Infarction flow grade before angioplasty), and electrocardiographic (ST-segment resolution) parameters showed significant correlations with the MSI (p < 0.001 for all). This study for the first time demonstrates that the MSI assessed by CMR predicts the outcome in acute reperfused ST-segment elevation myocardial infarction. Therefore, MSI assessment has important implications for patient prognosis as well as for the design of future trials intended to test new reperfusion therapy efficacy. (Myocardial Salvage Assessed by Cardiovascular Magnetic Resonance-Impact on Outcome; NCT00952224).

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Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation.

Monvadi B Srichai, Chelif Junor, L. Rodriguez … (2006)

Left ventricular (LV) thrombus is a frequent and potentially dangerous complication of ischemic heart disease (IHD). We evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus and compared the diagnostic value of contrast-enhanced magnetic resonance imaging (MRI) with transthoracic (TTE) and transesophageal echocardiography (TEE) for the diagnosis of LV thrombi. Between November 1997 and December 2003, 361 patients with IHD had surgical and/or pathological confirmation of presence or absence of LV thrombus. Clinical information and preoperative imaging study reports were retrospectively reviewed regarding detection of thrombus. Comparisons were made between clinical and imaging characteristics of patients with and without confirmed thrombus. Left ventricular thrombus was present in 106 (29%) of 361 patients in this study. Patients with thrombus had a higher incidence of recent embolic events (6.1% vs 0.8%, P < .005). In 160 patients with all 3 imaging modalities performed within 30 days of surgical or pathological confirmation, contrast-enhanced MRI showed the highest sensitivity and specificity (88% +/- 9% and 99% +/- 2%, respectively) compared with TTE (23% +/- 12% and 96% +/- 3.6%, respectively) and TEE (40% +/- 14% and 96% +/- 3.6%, respectively) for thrombus detection. Left ventricular thrombus occurs frequently in patients with IHD and is associated with risk of systemic embolization. Contrast-enhanced MRI provided the highest sensitivity and specificity for LV thrombus when compared to TTE and TEE, and should be considered in the care of patients at high risk of LV thrombus formation.

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Author and article information

Journal

Journal ID (nlm-ta): Cardiol Res Pract

Journal ID (publisher-id): CRP

Title: Cardiology Research and Practice

Publisher: SAGE-Hindawi Access to Research

ISSN (Print): 2090-8016

ISSN (Electronic): 2090-0597

Publication date (Print): 2011

Publication date (Electronic): 19 October 2011

Volume: 2011

Electronic Location Identifier: 605785

Affiliations

¹Cardiology Division, Department of Medicine, University of Virginia Health System, 1215 Lee Street, P.O. Box 800158, Charlottesville, VA 22908, USA

²Department of Radiology, University of Virginia Health System, 1215 Lee Street, P.O. Box 800158, Charlottesville, VA 22908, USA

³Department of Biomedical Engineering, University of Virginia Health System, 1215 Lee Street, P.O. Box 800158, Charlottesville, VA 22908, USA

Author notes

*Michael Salerno: ms5pc@ 123456virginia.edu

Academic Editor: Igor Klem

Article

DOI: 10.4061/2011/605785

PMC ID: 3199125

PubMed ID: 22028981

SO-VID: a05c6edf-8186-4201-8358-575cd8dfd03b

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.