Abstract
Only few data are available regarding a direct comparison of both non-invasive CMR and invasive EMB with respect to conformity of procedure-derived diagnoses in the same patients. The aim of this study was to elucidate the diagnostic performance of non-invasive cardiovascular magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB) in patients with troponin-I (TnI) positive acute chest pain in the absence of significant coronary artery disease (CAD). One thousand one hundred and seventy-four consecutive patients who were admitted with TnI-positive acute chest pain between March 2004 and July 2007 underwent coronary angiography. In 1012 patients (86%), significant CAD (stenosis >50%) was detected as underlying reason for the acute chest pain. In 82 out of the remaining 162 patients without significant CAD, further workup was performed including both CMR and EMB. Cardiovascular magnetic resonance imaging alone enabled a diagnosis in 66/82 (80%) and EMB alone in 72/82 (88%) patients (P = 0.31). Myocarditis was the most frequent diagnosis by both CMR and EMB in this cohort and was detected with a higher frequency by EMB (58 vs. 81%; P < 0.001). With the combined approach comprising CMR and EMB, a final diagnosis could be established applying the 'Believe-The-Positive-Rule' in 78/82 patients (95%). This combined approach turned out to yield more diagnoses than either CMR (P < 0.001) or EMB (P = 0.03) as single techniques, respectively. Comparison of diagnostic CMR procedures with the corresponding diagnostic EMBs demonstrated a substantial match of diagnoses (kappa = 0.70). Cardiovascular magnetic resonance imaging and EMB have good diagnostic performances as single techniques in patients with TnI-positive acute chest pain in the absence of CAD. The combined application of CMR and EMB yields a considerable diagnostic synergy by overcoming some limitations of CMR and EMB as individually applied techniques.
Highlights
Measurement of troponin release has enabled further detailed classification and risk stratification in acute chest pain syndromes.[1]Coronary artery disease (CAD) constitutes the number one cause for troponin elevations in the setting of acute chest pain
The present study was performed on a large TnI-positive patient group who had CAD ruled out by early coronary angiography and demonstrates that both cardiovascular magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB) are highly valuable diagnostic tools to establish underlying diagnoses
While myocarditis was diagnosed more often by EMB, including more subtle patterns, late-gadolinium enhancement (LGE)-CMR had an excellent performance in the setting of histologically more distinct forms of myocarditis
Summary
Measurement of troponin release has enabled further detailed classification and risk stratification in acute chest pain syndromes.[1]Coronary artery disease (CAD) constitutes the number one cause for troponin elevations in the setting of acute chest pain. Non-obstructed coronary arteries are, found on immediate cardiac catheterization in a sizeable subgroup of 10% and more patients with troponin elevation.[2,3,4] The absence of coronary lesions in this setting confronts the clinician with a broad variety of possible underlying aetiologies including myocarditis, different cardiomyopathies, aortic disease, embolic and vasospastic infarction, pulmonary embolism, arrhythmias, valvular heart disease, sepsis, and further rare conditions.[5,6] Due to this heterogeneous spectrum of differential diagnoses, a commonly accepted diagnostic pathway to identify the underlying disease in those individuals is still missing These patients represent a high-risk group even in the absence of CAD3 and a diagnosis is the basis for targeting therapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
