Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography
Abstract Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous clinical entity, encompassing multiple different causes, and a cause of substantial morbidity and mortality. Current guidelines suggest a multimodality imaging approach in establishing the underlying cau...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022787 |
| _version_ | 1818329600267124736 |
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| author | Brent Gudenkauf Allison G. Hays Jacqueline Tamis‐Holland Jeffrey Trost Daniel I. Ambinder Katherine C. Wu Armin Arbab‐Zadeh Roger S. Blumenthal Garima Sharma |
| author_facet | Brent Gudenkauf Allison G. Hays Jacqueline Tamis‐Holland Jeffrey Trost Daniel I. Ambinder Katherine C. Wu Armin Arbab‐Zadeh Roger S. Blumenthal Garima Sharma |
| author_sort | Brent Gudenkauf |
| collection | DOAJ |
| description | Abstract Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous clinical entity, encompassing multiple different causes, and a cause of substantial morbidity and mortality. Current guidelines suggest a multimodality 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. |
| first_indexed | 2024-12-13T12:50:38Z |
| format | Article |
| id | doaj.art-8c45ef7786554633bc4eeafcad4461c3 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T12:50:38Z |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-8c45ef7786554633bc4eeafcad4461c32022-12-21T23:45:21ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-01-0111110.1161/JAHA.121.022787Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary AngiographyBrent Gudenkauf0Allison G. Hays1Jacqueline Tamis‐Holland2Jeffrey Trost3Daniel I. Ambinder4Katherine C. Wu5Armin Arbab‐Zadeh6Roger S. Blumenthal7Garima Sharma8Division of Cardiology Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology Mount Sinai‐ Morning Side New York City NYDivision of Cardiology Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDDivision of Cardiology Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MDAbstract Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous clinical entity, encompassing multiple different causes, and a cause of substantial morbidity and mortality. Current guidelines suggest a multimodality 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.https://www.ahajournals.org/doi/10.1161/JAHA.121.022787angiographycomputerized tomographymagnetic resonance imagingmyocardial infarctionoptical coherence tomography |
| spellingShingle | Brent Gudenkauf Allison G. Hays Jacqueline Tamis‐Holland Jeffrey Trost Daniel I. Ambinder Katherine C. Wu Armin Arbab‐Zadeh Roger S. Blumenthal Garima Sharma Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angiography computerized tomography magnetic resonance imaging myocardial infarction optical coherence tomography |
| title | Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography |
| title_full | Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography |
| title_fullStr | Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography |
| title_full_unstemmed | Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography |
| title_short | Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography |
| title_sort | role of multimodality imaging in the assessment of myocardial infarction with nonobstructive coronary arteries beyond conventional coronary angiography |
| topic | angiography computerized tomography magnetic resonance imaging myocardial infarction optical coherence tomography |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022787 |
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