ArticleFrontiers in cardiovascular medicine2025
A novel multimodal imaging approach for working diagnosis of acute myocardial infarction with non-obstructive coronary arteries: a promising diagnostic strategy.
Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Percentage of Low-Attenuation Epicardial Adipose Volume (LAAV%) as an Independent Predictor of Coronary Microvascular Dysfunction: A Retrospective Cohort Study.Reviews in cardiovascular medicine · 2026Article
- Prognostic incremental value of perivascular adipose tissue in myocardial infarction with non-obstructive coronary arteries: a multicenter cohort study.Quantitative imaging in medicine and surgery · 2026Article
- Cardiac MRI Across ESC Guidance in the Last Decade.Clinical cardiology · 2026Review
- Multimodality cardiovascular imaging in arrhythmic mitral valve prolapse: a state-of-the-art review from structural assessment to myocardial tissue characterization.Frontiers in cardiovascular medicine · 2026Review
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Abstract
Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) demands prompt mechanistic clarification. Early integration of coronary CT angiography (CCTA) and cardiovascular magnetic resonance (CMR) can refine diagnosis during the acute phase. Methods: Twenty-one consecutive patients (41 ± 10 years; 71% men) presenting with troponin-positive chest pain and unobstructed coronaries underwent CCTA, delayed iodine-enhanced CT for late iodine enhancement (LIE), and CMR imaging within 14 days, with a mean interval of 5 days [interquartile range (IQR) 2-9] between both imaging modalities. CCTA assessed luminal stenosis and high-risk plaque; LIE mapped iodine retention; CMR evaluated myocardial edema and late gadolinium enhancement (LGE). Clinical, electrocardiographic, and laboratory data were collected. Results: Eight patients were classified as MINOCA and 13 as acute myocarditis. Chest pain was universal; dyspnea and syncope occurred in seven and two patients, respectively. Median peak high-sensitivity troponin-I was 1,569 ng/L (IQR 589-5 771). Biventricular systolic function was preserved (mean LVEF 58%; RVEF 55%). LGE appeared in 16 subjects: subendocardial in every MINOCA case and intramural or subepicardial in eight myocarditis cases. Myocardial edema was present in 15 patients. CCTA showed no atherosclerosis in 16 patients; five displayed non-obstructive lesions (<50% stenosis) with high-risk plaque confined to three MINOCA subjects. LIE confirmed iodine uptake matching the LGE pattern in all MINOCA patients and in six with myocarditis. Conclusions: An acute CCTA-CMR protocol may aid in distinguishing ischemic from non-ischemic myocardial injury in presumed MINOCA and unmasks occult high-risk plaques. This multimodal imaging approach reveals occult high-risk coronary plaques and enhances diagnostic accuracy, thereby supporting mechanism-targeted management strategies in patients presenting with troponin-positive chest pain.
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