Role of Multimodality Imaging in the Assessment of Myocardial Infarction With Nonobstructive Coronary Arteries: Beyond Conventional Coronary Angiography

Brent Gudenkauf, Allison G. Hays, Jacqueline Tamis-Holland, Jeffrey Trost, Daniel I. Ambinder, Katherine C. Wu, Armin Arbab-Zadeh, Roger S. Blumenthal, Garima Sharma

Research output: Contribution to journalShort surveypeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish
Article numbere022787
JournalJournal of the American Heart Association
Volume11
Issue number1
DOIs
StatePublished - 4 Jan 2022
Externally publishedYes

Keywords

  • Angiography
  • Computerized tomography
  • Magnetic resonance imaging
  • Myocardial infarction
  • Optical coherence tomography

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