Diagnostic étiologique de l’infarctus du myocarde à coronaires non-obstructives (MINOCA) : apport de l’imagerie par résonance magnétique de rehaussement tardif haute résolution en respiration libre

Abstract : Background: cardiac magnetic resonance (CMR) plays a pivotal role for the diagnosis of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA). However, the diagnosis remains uncertain in a significant number of patients, CMR being either negative or inconclusive. Objectives: to assess the diagnostic yield of CMR including high-resolution late gadolinium-enhanced imaging (HR-LGE) in patients with MINOCA. Methods: Consecutive patients categorized as MINOCA after blood testing, ECG, coronary angiography, and echocardiography, underwent conventional CMR including cine, T2-weighted, first-pass perfusion and breath-held LGE imaging. HR-LGE using a free-breathing method was systematically added to the protocol when conventional CMR was negative or inconclusive, and was optional otherwise. Diagnoses retained after reviewing conventional CMR were compared to those retained after the adjunction of HR-LGE. Results: from 2013 to 2016, 229 patients were included (age 56±17 years, 45% women). A definite diagnosis was retained after conventional CMR in 138(60%) patients: infarction in 56(24%), myocarditis in 57(25%), tako-tsubo cardiomyopathy in 22(10%), and other in 3(1%). In the remaining 91(40%) patients the diagnosis remained uncertain: negative CMR in 59(26%), consistent with multiple diagnoses in 32(14%). HR-LGE was performed in 172(75%) of the population, leading to a change in final diagnosis in 45(26%) of these patients, and to a lower rate of uncertain final diagnosis (29% vs. 50%, P<0.001). HR-LGE was particularly useful when TTE, ventriculography, and conventional CMR were negative. Conclusions: HR-LGE imaging has high diagnostic value in patients with MINOCA. This has major diagnostic, prognostic and therapeutic implications.
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Master Thesis
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Pierre-François Lintingre. Diagnostic étiologique de l’infarctus du myocarde à coronaires non-obstructives (MINOCA) : apport de l’imagerie par résonance magnétique de rehaussement tardif haute résolution en respiration libre. Médecine humaine et pathologie. 2017. ⟨dumas-01623939⟩

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