Spasm ofSmall Coronary Arteries and Ischemic Myocardial Injury
Diagnostic yield of early versus late outpatient Cardiac MRI in suspected acute coronary syndrome in...
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POSTER PRESENTATION Open Access Diagnostic yield of early versus late outpatient Cardiac MRI in suspected acute coronary syndrome in patients with normal coronary arteries Daniel Swarbrick * , Rajiv Das, Nicholas M Child From 16th Annual SCMR Scientific Sessions San Francisco, CA, USA. 31 January - 3 February 2013 Background Cardiac MRI (CMR) is increasingly recognized as a valu- able imaging modality for the investigation of patients with suspected acute coronary syndrome found to have non obstructive coronary arteries on angiography. Studies have shown that early CMR within 48 hours can facilitate diagnosis of important differential diagnoses, particularly myocarditis. We attempted to demonstrate whether later scanning, after 6 weeks, would still have a similar pick up rate for these diagnoses, compared with earlier CMR within 6 weeks. Methods 64 patients with suspected acute coronary syndrome referred for coronary angiography at a tertiary cardiac centre who had normal coronary arteries enrolled to the study and were entered into a prospective registry. All underwent cardiac MRI. Axial black blood, multiplanar cines, STIR and delayed enhancement sequences were taken. The first 32 patients had cardiac MRI performed after 6 weeks, and the subsequent 32 had MRI performed within 6 weeks. The two groups were compared with respect to diagnoses made on MRI, as well as demo- graphics and baseline troponin concentrations. Results 32 patients underwent CMR scanning after 6 weeks, at an average of 50.5 days. The final diagnoses were myocardial infarction (36%), myocarditis (13%), Takotsubo cardio- myopathy (6%) and non-diagnostic (45%). The subsequent 32 patients underwent CMR within 6 weeks, at an average of 22.6 days. The final diagnoses in this group were myocardial infarction (19%), myocarditis (41%), Takotsubo cardiomyopathy (13%), non-diagnostic (25%) and hyper- trophic cardiomyopathy (single case). Conclusions Outpatient CMR performed on patients with suspected acute coronary syndrome but with normal coronary arteries later than 6 weeks has a lower diagnostic yield compared to early outpatient CMR within 6 weeks. The pick up rate for myocarditis on CMR within 6 weeks is comparable to that in previous studies of CMR per- formed within 48 hours of admission, suggesting that it is feasible to perform scans during this time without compromising diagnostic yield. Funding No external funding was received. Published: 30 January 2013 doi:10.1186/1532-429X-15-S1-E67 Cite this article as: Swarbrick et al.: Diagnostic yield of early versus late outpatient Cardiac MRI in suspected acute coronary syndrome in patients with normal coronary arteries. Journal of Cardiovascular MagneticResonance 2013 15(Suppl 1):E67. Cardiothoracic, Freeman Hospital, Newcastle upon Tyne, UK Swarbrick et al. Journal of Cardiovascular Magnetic Resonance 2013, 15(Suppl 1):E67 http://www.jcmr-online.com/content/15/S1/E67 © 2013 Swarbrick et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transcript of Diagnostic yield of early versus late outpatient Cardiac MRI in suspected acute coronary syndrome in...
POSTER PRESENTATION Open Access
Diagnostic yield of early versus late outpatientCardiac MRI in suspected acute coronarysyndrome in patients with normal coronaryarteriesDaniel Swarbrick*, Rajiv Das, Nicholas M Child
From 16th Annual SCMR Scientific SessionsSan Francisco, CA, USA. 31 January - 3 February 2013
BackgroundCardiac MRI (CMR) is increasingly recognized as a valu-able imaging modality for the investigation of patientswith suspected acute coronary syndrome found to havenon obstructive coronary arteries on angiography. Studieshave shown that early CMR within 48 hours can facilitatediagnosis of important differential diagnoses, particularlymyocarditis. We attempted to demonstrate whether laterscanning, after 6 weeks, would still have a similar pick uprate for these diagnoses, compared with earlier CMRwithin 6 weeks.
Methods64 patients with suspected acute coronary syndromereferred for coronary angiography at a tertiary cardiaccentre who had normal coronary arteries enrolled to thestudy and were entered into a prospective registry. Allunderwent cardiac MRI. Axial black blood, multiplanarcines, STIR and delayed enhancement sequences weretaken. The first 32 patients had cardiac MRI performedafter 6 weeks, and the subsequent 32 had MRI performedwithin 6 weeks. The two groups were compared withrespect to diagnoses made on MRI, as well as demo-graphics and baseline troponin concentrations.
Results32 patients underwent CMR scanning after 6 weeks, at anaverage of 50.5 days. The final diagnoses were myocardialinfarction (36%), myocarditis (13%), Takotsubo cardio-myopathy (6%) and non-diagnostic (45%). The subsequent32 patients underwent CMR within 6 weeks, at an average
of 22.6 days. The final diagnoses in this group weremyocardial infarction (19%), myocarditis (41%), Takotsubocardiomyopathy (13%), non-diagnostic (25%) and hyper-trophic cardiomyopathy (single case).
ConclusionsOutpatient CMR performed on patients with suspectedacute coronary syndrome but with normal coronaryarteries later than 6 weeks has a lower diagnostic yieldcompared to early outpatient CMR within 6 weeks. Thepick up rate for myocarditis on CMR within 6 weeks iscomparable to that in previous studies of CMR per-formed within 48 hours of admission, suggesting that itis feasible to perform scans during this time withoutcompromising diagnostic yield.
FundingNo external funding was received.
Published: 30 January 2013
doi:10.1186/1532-429X-15-S1-E67Cite this article as: Swarbrick et al.: Diagnostic yield of early versus lateoutpatient Cardiac MRI in suspected acute coronary syndrome inpatients with normal coronary arteries. Journal of CardiovascularMagneticResonance 2013 15(Suppl 1):E67.
Cardiothoracic, Freeman Hospital, Newcastle upon Tyne, UK
Swarbrick et al. Journal of Cardiovascular MagneticResonance 2013, 15(Suppl 1):E67http://www.jcmr-online.com/content/15/S1/E67
© 2013 Swarbrick et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.
