Valor de la resonancia magnética cardíaca para el diagnóstico diferencial en pacientes con sospecha de infarto agudo de miocardio con elevación del segmento ST y arterias coronarias normales

• Autores: Rienzi Díaz-Navarro, Danilo Silva-González, Carlos Henríquez Roldán
• Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 148, Nº. 10, 2020, págs. 1406-1417
• Idioma: español
• Títulos paralelos:
  • Cardiac magnetic resonance imaging in patients with a suspected myocardial infarction and normal coronary arteries
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• Resumen

  • Background: Patients hospitalized with suspected ST-segment elevation myocardial infarction (STEMI) who have normal coronary arteries (CAs) on invasive coronary angiography (ICA) may have an AMI or another acute cardiac disease that mimics it. Aim: To evaluate the usefulness of cardiac magnetic resonance imaging (CMRI) for diagnosing conditions resembling AMI with normal CAs. Material and Methods: We studied 424 consecutive patients admitted with suspected STEMI who underwent ICA. Those with normal CAs underwent CMRI involving cine-CMRI sequences to evaluate segmental wall motion, T2-weighted short-tau inversion-recovery imaging to detect oedema and delayed contrast enhancement (DCE) after gadolinium administration to identify necrosis/fibrosis. Patients with previous myocardial infarction were excluded. Results: Twenty-six patients (6.1%) had normal CAs. Definitive diagnosis after CMRI was acute myocarditis in 11 patients (42.3%) whose DCE was localized in the subepicardium or intramyocardially but not in the endocardium, AMI in nine patients (34.6%) who had subendocardial or transmural DCE, and Takotsubo cardiomyopathy (TCM) in six patients (23.1%), whose CMRI showed regional contractility abnormalities of the left ventricle and myocardial oedema but not DCE. Conclusions: Cardiac magnetic resonance imaging allows a precise diagnosis of acute myocardial infarction in patients with angiographically normal coronary arteries.