Utility of cardiovascular magnetic resonance in patients with stable troponin elevation. (7th November 2022)

• Record Type: Journal Article
• Authors: Ananthakrishna, Rajiv; Rajvi, Benita P; Hancock, Diana E; Kholmurodova, Feruza; Woodman, Richard J; Patil, Sanjana; Horsfall, Matthew; Chew, Derek P; Daril, Noor Darinah Mohd; Selvanayagam, Joseph B
• Is Part Of: European heart journal. Volume 24:Number 2(2023)
• Page Start: 192
• Page End: 201
• Publication Date: 2022-11-07
• Subjects: cardiovascular magnetic resonance -- stable troponin elevation -- diagnosis; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeac215
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: Cardiovascular magnetic resonance (CMR) imaging has a potential role in the evaluation of symptomatic patients with stable troponin elevation; however, its utility remains unexplored. We sought to determine the incremental diagnostic value of CMR in this unique cohort and assess the long-term clinical outcomes. Methods and results: Two hundred twenty-five consecutive patients presenting with cardiac chest pain/dyspnoea, stable troponin elevation, and undergoing CMR assessment were identified retrospectively from registry database. The study cohort was prospectively followed for major adverse cardiac events (MACEs) (defined as composite of all-cause mortality and cardiovascular readmissions). The primary outcome measure was the diagnostic utility of CMR, i.e. percentage of patients for whom CMR identified the cause of stable troponin elevation. Secondary outcome measures included the incremental value of CMR and occurrence of MACE. CMR was able to identify the cause for stable troponin elevation in 160 (71%) patients. A normal CMR was identified in 17% and an inconclusive CMR in 12% of the patients. CMR changed the referral diagnosis in 59 (26%) patients. Utilizing a baseline prediction model (pre-CMR referral diagnosis), the net reclassification index was 0.11 and integrated discriminatory improvement index measured 0.33 following CMR. Over a median follow-up of 4.3 years (interquartile range 2.8–6.3), 72 (32%) patients experienced MACE. Conclusion: CMR identified a cause for stable troponin elevation in 7 of 10 cases, and a new diagnosis was evident in 1 of 4 cases. CMR improved the net reclassification of patients with stable troponin elevation. Graphical Abstract: Graphical Abstract CMR in stable troponin elevation. CMR was able to identify a cause for stable troponin elevation in a considerable proportion of symptomatic patients. CMR also improved the net reclassification of patients with stable troponin elevation. LGE pattern in different diagnostic categories are illustrated—NICM: linear striae of mid-myocardial hyperenhancement in the septal wall in a case of idiopathic dilated cardiomyopathy, IHD: transmural LGE in the anterior and anteroseptal segments (corresponding to left anterior descending artery territory), HCM: patchy LGE in hypertrophied septum with prominent right ventricular insertion point fibrosis, CA: global biventricular transmural LGE. (CA: cardiac amyloidosis; CMR: cardiovascular magnetic resonance; HCM: hypertrophic cardiomyopathy; hs-cTnT: high sensitivity cardiac troponin T; IDI: integrated discriminatory improvement index; IHD: ischaemic heart disease; LGE: late gadolinium enhancement; MACE: major adverse cardiac events; NICM: non-ischaemic cardiomyopathy, NRI: net reclassification index.)