TY - JOUR
T1 - Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries
T2 - Beyond Conventional Coronary Angiography
AU - Gudenkauf, Brent
AU - Hays, Allison G.
AU - Tamis-Holland, Jacqueline
AU - Trost, Jeffrey
AU - Ambinder, Daniel I.
AU - Wu, Katherine C.
AU - Arbab-Zadeh, Armin
AU - Blumenthal, Roger S.
AU - Sharma, Garima
N1 - Funding Information:
Dr Sharma is supported by the Blumenthal Scholarship in Preventive Cardiology.
Publisher Copyright:
© 2021 The Authors.
PY - 2022/1/4
Y1 - 2022/1/4
N2 - Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous clinical entity, encom-passing multiple different causes, and a cause of substantial morbidity and mortality. Current guidelines suggest a multimo-dality imaging approach in establishing the underlying cause for MINOCA, which is considered a working diagnosis. Recent studies have suggested that an initial workup consisting of cardiac magnetic resonance and invasive coronary imaging can yield the diagnosis in most patients. Cardiac magnetic resonance is particularly helpful in excluding nonischemic causes that can mimic MINOCA including myocarditis and Takotsubo cardiomyopathy, as well as for long-term prognostication. Additionally, intracoronary imaging with intravascular ultrasound or optical coherence tomography may be warranted to evaluate plaque composition, or evaluate for plaque disruption or spontaneous coronary dissection. The role of noninvasive imaging modalities such as coronary computed tomography angiography is currently being investigated in the diagnostic approach and follow-up of MINOCA and may be appropriate in lieu of invasive coronary angiography in select patients. In recent years, many strides have been made in the workup of MINOCA; however, significant knowledge gaps remain in the field, particularly in terms of treatment strategies. In this review, we summarize recent society guideline recommendations and consensus statements on the initial evaluation of MINOCA, review contemporary multimodality imaging approaches, and discuss treatment strategies including an ongoing clinical trial.
AB - Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous clinical entity, encom-passing multiple different causes, and a cause of substantial morbidity and mortality. Current guidelines suggest a multimo-dality imaging approach in establishing the underlying cause for MINOCA, which is considered a working diagnosis. Recent studies have suggested that an initial workup consisting of cardiac magnetic resonance and invasive coronary imaging can yield the diagnosis in most patients. Cardiac magnetic resonance is particularly helpful in excluding nonischemic causes that can mimic MINOCA including myocarditis and Takotsubo cardiomyopathy, as well as for long-term prognostication. Additionally, intracoronary imaging with intravascular ultrasound or optical coherence tomography may be warranted to evaluate plaque composition, or evaluate for plaque disruption or spontaneous coronary dissection. The role of noninvasive imaging modalities such as coronary computed tomography angiography is currently being investigated in the diagnostic approach and follow-up of MINOCA and may be appropriate in lieu of invasive coronary angiography in select patients. In recent years, many strides have been made in the workup of MINOCA; however, significant knowledge gaps remain in the field, particularly in terms of treatment strategies. In this review, we summarize recent society guideline recommendations and consensus statements on the initial evaluation of MINOCA, review contemporary multimodality imaging approaches, and discuss treatment strategies including an ongoing clinical trial.
KW - Angiography
KW - Computerized tomography
KW - Magnetic resonance imaging
KW - Myocardial infarction
KW - Optical coherence tomography
UR - http://www.scopus.com/inward/record.url?scp=85123297073&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85123297073&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.022787
DO - 10.1161/JAHA.121.022787
M3 - Short survey
C2 - 34970915
AN - SCOPUS:85123297073
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 1
M1 - e022787
ER -