The unique value of cardiovascular magnetic resonance in patients with suspected acute coronary syndrome and culprit-free coronary angiograms.

BACKGROUND: Patients with chest pain, elevated troponin, and unobstructed coronary disease present a clinical dilemma. The purpose of this study was to investigate the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in a cohort of patients with suspected acute coronary syndrome (ACS) and unobstructed coronary arteries. RESULTS: Data files of patients meeting the inclusion criteria in two cardiology centres were searched and analysed. The inclusion criteria included: 1) thoracic pain suspected with ACS; 2) a significant increase in the high-sensitive Troponin T value; 3) ECG changes; 4) coronary arteries without any significant stenosis; 5) a CMR examination included in the diagnostic process; 6) an uncertain diagnosis before the CMR exam; and 7) the absence of known CMR and contrast media contraindications. Special attention was paid to the benefits of CMR in determining the final diagnosis. In total, 136 patients who underwent coronary angiography for chest pain were analysed. The most frequent underlying causes were myocarditis (38%) and perimyocarditis (18%), followed by angiographically unrecognised acute myocardial infarction (18%) and Takotsubo cardiomyopathy (15%). The final diagnosis remained unclear in 6% of the patients. The contribution of CMR in determining the final diagnosis determination was crucial in 57% of the patients. In another 35% of the patients, CMR confirmed the suspicion and, only 8% of the CMR examinations did not help at all and had no influence on diagnosis or treatment. CONCLUSION: CMR provided a powerful incremental diagnostic value in the cohort of patients with suspected ACS and unobstructed coronary arteries. CMR is highly recommended to be incorporated as an inalienable part of the diagnostic algorithms in these patients.

[The role of cardiovascular magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Part II]. / Význam zobrazení srdce pomocí magnetické rezonance v diagnostice hypertrofické kardiomyopatie Cást II.

Hypertrophic cardiomyopathy is currently understood as a group of diseases with left ventricular hypertrophy, which are not based on adaptive mechanisms. The first part of the review details the possibility of cardiac magnetic resonance in the diagnosis of sarcomeric forms of hypertrophic cardiomyopathy, the second part will focus on the possibilities of distinguishing the sarcomeric forms from their phenocopies.Key words: cardiac magnetic resonance - hypertrophic cardiomyopathy - phenocopies.

[The role of cardiovascular magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Part I]. / Význam zobrazení srdce pomocí magnetické rezonance v diagnostice hypertrofické kardiomyopatieCást I.

Hypertrophic cardiomyopathy is the most common genetic cardiomyopathy in our population. The diagnosis of this disease is based on imaging methods, mainly echocardiography. Cardiac magnetic resonance offers more accurate and detailed information about the disease than echocardiography. Development of this method has become a standard part of the diagnostic algorithm. In the first part of review, the authors analyze the potential and significance of cardiac magnetic resonance in the diagnosis of hypertrophic cardiomyopathy.Key words: cardiac magnetic resonance - fibrosis - hypertrophic cardiomyopathy.