医学
心肌炎
医学诊断
队列
回顾性队列研究
内科学
急性冠脉综合征
冠状动脉造影
鉴别诊断
心脏病学
磁共振成像
放射科
心脏磁共振
临床诊断
心肌梗塞
儿科
病理
作者
Kate Liang,Giandomenico Bisaccia,Isabella Leo,Mark Williams,Amardeep Ghosh Dastidar,Julian Strange,Eva Sammut,Tom Johnson,Chiara Bucciarelli-Ducci
出处
期刊:European Journal of Echocardiography
[Oxford University Press]
日期:2023-08-01
卷期号:25 (1): 8-15
被引量:1
标识
DOI:10.1093/ehjci/jead182
摘要
In ∼5-15% of all cases of acute coronary syndromes (ACS) have unobstructed coronaries on angiography. Cardiac magnetic resonance (CMR) has proven useful to identify in most patients the underlying diagnosis associated with this presentation. However, the role of CMR to reclassify patients from the initial suspected condition has not been clarified. The aim of this study was to assess the proportion of patients with suspected MINOCA, or non-MINOCA, that CMR reclassifies with an alternative diagnosis from the original clinical suspicion.A retrospective cohort of patients in a tertiary cardiology centre was identified from a registry database. Patients who were referred for CMR for investigation of suspected MINOCA, and a diagnosis pre- and post-CMR was recorded to determine the proportion of diagnoses reclassified. A total of 888 patients were identified in the registry. CMR reclassified diagnosis in 78% of patients. Diagnosis of MINOCA was confirmed in only 243 patients (27%), whilst most patients had an alternative diagnosis (73%): myocarditis n = 217 (24%), Takotsubo syndrome n = 115 (13%), cardiomyopathies n = 97 (11%), and normal CMR/non-specific n = 216 (24%).In a large single-centre cohort of patients presenting with ACS and unobstructed coronary arteries, most patients had a non-MINOCA diagnosis (73%) (myocarditis, Takotsubo, cardiomyopathies, or normal CMR/non-specific findings), whilst only a minority had confirmed MINOCA (27%). Performing CMR led to reclassifying patients' diagnosis in 78% of cases, thus confirming its important clinical role and underscoring the clinical challenge in diagnosing MINOCA and non MINOCA conditions.
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