Clinical and CMR discrepancies in relation to final diagnosis in patients hospitalized due to acute cardiovascular symptoms and excluded obstructive coronary artery disease
M Wegiel, B Zdzierak, B Chyrchel, W Wojciechowska, A Dziewierz, S Bartus, A Surdacki, T RakowskiAbstract
Background
Population of patients with acute cardiovascular symptoms and elevated troponin levels encompasses a heterogenous cohort in terms of final diagnosis and possible clinical outcome.
Purpose
The aim of this study was to assess clinical characteristics, heart failure indexes and cardiac magnetic resonance (CMR) details in relation to final diagnosis in patients with acute condition and excluded or without suspicion of obstructive coronary artery disease (CAD).
Methods
Observational study of patients hospitalized in years 2021-2025, who were urgently admitted due to acute cardiovascular symptoms with elevated troponin levels and underwent comprehensive assessment due to lack of clear diagnosis with obstructive CAD or other medical condition. Diagnostics with echocardiography, coronary tomography or angiography and CMR with T1/T2 mapping and extracellular volume (ECV) calculation as well as late gadolinium enhancement (LGE) analysis were performed.
Results
Total amount of 64 patients were analyzed. The most frequent final diagnosis was myocarditis (64%) and in the second place (12,5%) confirmed myocardial infarction with non-obstructive coronary arteries (MINOCA). Following diagnoses included takotsubo cardiomyopathy (8%), myocardial infarction due to paradoxical embolism and myocardial bridge (3%), dilated cardiomyopathy (1.5%) and changes related to previous incident of myocarditis (1.5%). In remaining 9% of patients there was no possibility to unequivocally determine the final diagnosis. Patients with two most common conditions: myocarditis and MINOCA were further analyzed. Patients with MINOCA were older, more frequently women, with more prevalent typical cardiovascular risk factors. On the other hand, patients with myocarditis experienced significantly longer delay from initial symptoms to hospital admission (Table 1). In CMR, patients with myocarditis had larger volumes of right and left ventricle and greater mass of left ventricle as well as greater extent of LGE. On the contrary, patients with MINOCA had longer maximal T2 times compared to those with myocarditis. No statistically significant differences in T1 mapping and ECV were observed between both groups of patients. See Table 2 for details.
Conclusions
In a cohort of patients with acute cardiac symptoms and excluded obstructive CAD, most met the criteria for myocarditis, which underpins crucial role of comprehensive assessment with CMR. Magnetic resonance revealed larger volumes of heart cavities, with greater extent of LGE in patients with myocarditis compared to those with confirmed MINOCA – second most frequent diagnosis in this group of patients. Significant delay between symptoms and hospital admission in patients with myocarditis should provoke increased clinical awareness of this clinical condition.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.