Paper of the Week

Myocardial infarction in women with normal coronaries: use of CMR
Circulation. 2011; 124: 1414-1425

Myocardial infarction with apparent normal epicardial arteries occurs in a specific number of cases especially in women. Dr Reynolds and cols analyzed 50 women with documented increase in troponin and invasive angiography plus IVUS with < 50% stenosis. An abnormal CMR was found in 59% of these women with LGE present in 34% and edema (by T2W imaging) in 18%. Interestingly, edema was correlated with myocardial segments irrigated by a coronary with plaque disruption. The most common pattern of LGE was transmural or subendocardial (10/17 - 59%) but mixed and purely nonischemic patterns were also rather frequent (41%). The authors conclude that the use of IVUS and especially of CMR can aid in the identification of the causes underlying such clinical situations with possible therapeutical consequences.