Suggested paper of the week

Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries (Int J Cardiovasc Imaging. 2011 May 3).

Dr Gerbaud and cols aimed to evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance (CMR) in 130 patients with chest pain, raised troponin and unobstructed coronary arteries, and to compare subsequent event rates between diagnostic groups. In their study, when a single diagnosis was suspected by the referring physician, CMR validated this diagnosis in 32 patients (76.2%). CMR provided a formal diagnosis in 61 patients (69.3%) in which the clinical diagnosis was uncertain between at least two possibilities. CMR corrected a wrong diagnosis in 10 patients (7.7%). CMR-suggested diagnosis led to a modification of therapy in 42 patients (32.3%). Median follow-up was 34 months in 124 patients. Sixteen patients (12.9%) experienced major adverse cardiovascular events (MACE), but MACE rate was not different between patients with a conclusive CMR and normal CMR. They concluded that in patients with acute troponin-positive chest pain and unobstructed coronary arteries, early CMR has important diagnostic and therapeutic implications. However its association with occurrence of MACE during mid term follow-up was not obvious.