Application norms and research progress of cardiac magnetic resonance imaging in the management of MINOCA patients

doi:10.16150/j.1671-2870.2024.02.001

Abstract

Abstract:

Myocardial infarction without obstructive coronary artery (MINOCA) refers to myocardial infarction (MI) that occurs when the lumen area of coronary artery stenosis is ≤50%, accounting for 1% to 14% of the total MI. The etio-logy of MINOCA is complex and diverse, and accurate diagnosis and identification of the potential causes of MINOCA are crucial for guiding subsequent clinical management. Based on the unique advantages of myocardial tissue imaging, non-invasive cardiac magnetic resonance (CMR) examination has been widely recognized for its value in the management of MINOCA patients. CMR can be used to exclude diseases similar to MI, such as myocarditis and stress-induced cardio-myopathy, and identify the potential causes of MINOCA. It is a necessary diagnostic tool in the diagnostic process, helping to reduce overdiagnosis, misdiagnosis, and missed diagnosis of true MINOCA. Currently, it has been recommended by the American Heart Association (AHA) and the European Society of Cardiology (ESC) as an essential examination method in the MINOCA management process. In addition, compared with patients with coronary artery occlusion, MINOCA patients have a better short-term prognosis, but the risk of poor prognosis increases in long-term follow-up. It is necessary to pay more attention to the prognosis and risk stratification of MINOCA patients and management process. The traditional MI prognosis evaluation system is not entirely applicable to MINOCA patients, and CMR can provide valuable information for the prognosis evaluation of MINOCA patients. Currently, there are no standardized norms or guidelines for the application of CMR in the management of MINOCA patients in China. This article aims to review the application norms and prognostic value of CMR technology in clinical management of MINOCA, providing reference for clinical practice and enhancing understanding and management of this special MI lesion.

Key words: Myocardial infarction, Myocardial infarction without obstructive coronary artery, Cardiac magnetic resonance, Clinical management

CLC Number:

ZHAO Xinxiang, ZHAO Xiaoying. Application norms and research progress of cardiac magnetic resonance imaging in the management of MINOCA patients[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(02): 101-107.

Figures/Tables 2

References 33

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诊断条件	具体内容
符合AMI诊断	Ⅰ.检测到心肌肌钙蛋白上升或下降，且至少有一个值超过第 99百分位数参考上限。 Ⅱ. MI确凿临床证据，至少表现为以下一项： a. 心肌缺血症状； b. 新的缺血性心电图变化； c. 出现病理性Q波； d. 影像学证据显示新的存活心肌丧失或新的区域室壁运动异常，其模式与缺血性病因一致； e. 通过血管造影或尸检发现冠状动脉血栓。
血管造影显示冠状动脉无明显阻塞	定义为血管造影显示任何主要心外膜血管无阻塞性疾病（即冠状动脉狭窄<50%），包括以下3项。 a. 冠状动脉正常（血管造影无狭窄）； b. 轻度管腔不规则（血管造影狭窄率<30%）； c. 中度冠状动脉粥样硬化病变（狭窄程度≥30%，但<50%）。部分冠状动脉狭窄30%~50%的患者会出现有临床意义的功能性冠状动脉狭窄，对于这些患者，冠状动脉血流储备分数>0.8才能诊断为 MINOCA。
临床表现无明确的替代诊断	替代诊断包括但不限于败血症、肺栓塞和心肌炎等非缺血性病因。