Imagerie par résonance magnétique et imagerie endocoronaire par tomographie par cohérence optique : acquisition, interprétation et intégration dans le diagnostic étiologique des MINOCA

Abstract

MINOCA is a heterogeneous entity with many possible etiologies that need to be clarified to optimize therapeutic interventions. Common causes include plaque disruption, plaque erosion, spontaneous coronary artery dissection, coronary artery spasm, coronary thromboembolism. Most of the time, coronary angiography is inadequate to obtain the proper identification of these underlying pathophysiological mechanisms. Within this context, myocardial tissue characterization with magnetic resonance imaging is key investigation to assess and locate recent myocardial infarctions and to exclude differential diagnostics such as myocarditis or takotsubo cardiomyopathy. In addition, optical coherence tomography is a powerful tool to visualize coronary intraluminal and superficial coronary artery structures in detail including the detection of plaque disruption signs, thrombus or dissections. The use of appropriate diagnostic algorithms combining both OCT and CMR seems to provide a clear substrate or diagnosis to many of the cases. This narrative review aims to expose both imaging modalities focusing on their contributions in the setting of MINOCA.