Register
Forgot your password?

The role of magnetic resonance imaging in myocardial infarction without obstructive coronary stenosis

Authors: Berdibekov B.Sh., Alexandrova S.A., Bulaeva N.I., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2025-19-1-7-16

For citation: Berdibekov B.Sh., Alexandrova S.A., Bulaeva N.I., Golukhova E.Z. The role of magnetic resonance imaging in myocardial infarction without obstructive coronary stenosis. Creative Cardiology. 2025; 19 (1): 7–16 (in Russ.). DOI: 10.24022/1997-3187-2025-19-1-7-16

Received / Accepted:  03.02.2025 / 07.02.2025

Keywords: myocardial infarction without obstructive coronary stenosis magnetic resonance imaging risk stratification prognosis



Subscribe 🔒

 

Abstract

Myocardial infarction without obstructive coronary stenosis (MINOCA) is characterized by clinical evidence of myocardial infarction and the absence of hemodynamically significant coronary stenosis (stenosis < 50%). The prevalence of MINOCA among patients diagnosed with myocardial infarction is 5-6%. According to current clinical guidelines, magnetic resonance imaging (MRI) of the heart is recommended as a key diagnostic tool in the MINOCA diagnostic algorithm, as it can exclude conditions such as myocarditis, Takotsubo syndrome, and cardiomyopathies, while also providing visual confirmation of myocardial necrosis. Furthermore, accumulating evidence supports the prognostic value of MRI in this patient population. This descriptive review aims to discuss the diagnostic and prognostic roles of MRI in patients with MINOCA.

References

  1. Sherashov A.V., Shilova A.S., Pershina E.S., Shchekochikhin D.Yu., Svet A.V., Gilyarov M.Yu. Myocardial infarction with nonobstructive coronary arteries. Kardiologiia. 2020; 60 (3): 89–95 (in Russ.). DOI: 10.18087/cardio.2020.3.n881
  2. Tamis-Holland J.E., Jneid H., Reynolds H.R., Agewall S., Brilakis E.S., Brown T.M. et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation. 2019; 139 (18): e891–e908. DOI: 10.1161/CIR.0000000000000670
  3. Ryabov V.V., Fedorova S.B., Vyshlov E.V. Myocardial infarction with nonobstructive coronary atherosclerosis as a current problem of emergency cardiology. Siberian Journal of Clinical and Experimental Medicine. 2018; 33 (4): 10–18 (in Russ.). DOI: 10.29001/2073-8552-2018-33-4-10-18
  4. Golukhova E.Z., Alexandrova S.A., Bulaeva N.I., Mrikaev D.V., Gromova O.I., Berdibekov B.Sh. Prognostic value of myocardial strain by magnetic resonance imaging in nonischemic dilated cardiomyopathy: a systematic review and meta-analysis. Kardiologiia. 2022; 62 (10): 35– 41 (in Russ.). DOI: 10.18087/cardio.2022.10.n2034
  5. Vorobieva D.A., Lugacheva Yu.G., Kapilevich N.A., Ryabov V.V. Comparative analysis of prothrombotic activity in patients with myocardial infarction with and without obstructive coronary artery disease. Russian Journal of Cardiology. 2021; 26 (2): 3939 (in Russ.). DOI: 10.15829/1560-4071-2021-3939
  6. Li B., Ming Z., Wu J., Zhang M. Nonobstructive coronary artery myocardial infarction complicated by heart failure, ventricular aneurysm, and incessant ventricular arrhythmia: a case report. Medicine (Baltimore). 2019; 98 (2): e13995. DOI: 10.1097/MD.0000000000013995.
  7. Smilowitz N.R., Mahajan A.M., Roe M.T., Hellkamp A.S., Chiswell K., Gulati M., Reynolds H.R. Mortality of myocardial infarction by sex, age, and obstructive coronary artery disease status in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). Circ. Cardiovasc. Qual. Outcomes. 2017; 10 (12): e003443. DOI: 10.1161/ CIRCOUTCOMES.116.003443
  8. Akhmadov I.I., Musaev M.M., Musalov A.Yu., Zakargaev R.K., Abzhuriev M.N., Mamalyga M.L., Alshibaya M.D. Transcatheter treatment of postinfarction false left ventricular aneurysm. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (4): 575–584 (in Russ.). DOI: 10.24022/0236-2791-2024-66-4-575-584
  9. Kalinin R.E., Suchkov I.A., Mzhavanadze N.D., Ncheye A.F. Posterobasal left ventricular aneurysm after myocardial infarction with normal coronary arteries: Case-report. World J. Clin. Cases. 2018; 6 (6): 139–142. DOI: 10.12998/wjcc.v6.i6.139
  10. Merzlyakov V.Yu., Skopin A.I., Krivenkova E.M., Salomov M.A. Surgical treatment of postinfarction left ventricle aneurysms on a beating heart. Historical and modern view of the problem. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2023; 65 (5): 522–531 (in Russ.). DOI: 10.24022/0236-2791-2023-65-5-522-531
  11. Takaseya T., Nishimi M., Kawara T., Tayama E., Fukunaga S., Yokose S., Chihara S. et al. Spontaneous coronary artery dissection causing myocardial infarction and left ventricular aneurysm. Circ J. 2002; 66 (10): 972–973. DOI: 10.1253/circj.66.972
  12. Song Y., Xu F., Feng W. Surgical treatment of left ventricular aneurysm in patients with prior myocardial infarction in the absence of obstructive coronary artery disease (MINOCA): a cohort study. J. Cardiothorac. Surg. 2023; 18 (1): 304. DOI: 10.1186/s13019-023-02385-0
  13. Görmeli C.A., Özdemir Z.M., Kahraman A.S., Yağmur J., Özdemir R., Çolak C. The evaluation of non-ischemic dilated cardiomyopathy with T1 mapping and ECV methods using 3T cardiac MRI. Radiol. Med. 2017; 122 (2): 106–112. DOI: 10.1007/s11547-016-0701-y
  14. Dastidar A.G., Rodrigues J.C.L., Johnson T.W., De Garate E., Singhal P., Baritussio A. et al. Myocardial Infarction With Nonobstructed Coronary Arteries: Impact of CMR Early After Presentation. JACC Cardiovasc. Imag. 2017; 10 (10 Pt A): 1204–1206. DOI: 10.1016/j.jcmg.2016.11.010
  15. Gatti M., Carisio A., D’Angelo T., Darvizeh F., Dell’Aversana S., Tore D. et al. Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries patients: a review. World J. Cardiol. 2020; 12 (6): 248–261. DOI: 10.4330/wjc.v12.i6.248
  16. Golukhova E.Z., Bulaeva N.I., Alexandrova S.A., Mrikaev D.V., Gromova O.I., Ruzina E.V., Berdibekov B.S. The extent of late gadolinium enhancement predicts mortality, sudden death and major adverse cardiovascular events in patients with nonischaemic cardiomyopathy: a systematic review and meta-analysis. Clin. Radiol. 2023; 78 (4): e342–e349. DOI: 10.1016/j.crad.2022.12.015
  17. Golukhova E.Z., Aleksandrova S.A., Berdibekov B.Sh. Predictive role of quantification of myocardial fibrosis using delayed contrast-enhanced magnetic resonance imaging in nonischemic dilated cardiomyopathies: a systematic review and meta-analysis. Russian Journal of Cardiology. 2021; 26 (12): 4776 (in Russ.). DOI: 10.15829/1560-4071-2021-4776
  18. Schultheiss H.P., Kühl U., Cooper L.T. The management of myocarditis. Eur. Heart J. 2011; 32 (21): 2616–2625. DOI: 10.1093/eurheartj/ehr165
  19. Berdibekov B.Sh., Aleksandrova S.A., Golukhova E.Z. Quantification of myocardial fibrosis in patients with a nonischemic ventricular arrhythmias by late gadolinium-enhanced magnetic resonance. Creative Cardiology. 2021; 15 (3): 342–353 (in Russ.). DOI: 10.24022/1997-3187-2021-15-3-342-353
  20. Boldueva S.A., Evdokimov D.S. Takotsubo cardiomyopathy. Literature review: clinical performance, diagnostic algorithm, treatment, prognosis. Part II. Russian Journal of Cardiology. 2022; 27 (3S): 4994 (in Russ.). DOI: 10.15829/1560-4071-2022-4994
  21. Kurowski V., Kaiser A., von Hof K., Killermann D.P., Mayer B., Hartmann F. et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest. 2007; 132 (3): 809–816. DOI: 10.1378/ chest.07-0608
  22. Eitel I., von Knobelsdorff-Brenkenhoff F., Bernhardt P., Carbone I., Muellerleile K., Aldrovandi A. et al. Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 2011; 306 (3): 277–286. DOI: 10.1001/jama.2011.992
  23. Daneshrad J.A., Ordovas K., Sierra-Galan L.M., Hays A.G., Mamas M.A., Bucciarelli-Ducci C., Parwani P. Role of cardiac magnetic resonance imaging in the evaluation of MINOCA. J. Clin. Med. 2023; 12 (5): 2017. DOI: 10.3390/jcm12052017
  24. Minaev A.V., Golubev E.P., Paraskevova D.P., Zemlyanskaya I.V., Podzolkov V.P. Surgical correction of abnormal left coronary artery from the pulmonary artery with stenosis of the left coronary artery. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2023; 24 (6): 616– 622 (in Russ.). DOI: 10.24022/1810-0694-2023-24-6-616-622
  25. Pathik B., Raman B., Mohd Amin N.H., Mahadavan D., Rajendran S., McGavigan A.D. et al. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur. Heart J. Cardiovasc. Imaging. 2016; 17 (10): 1146–1152. DOI: 10.1093/ehjci/jev289
  26. Liang K., Bisaccia G., Leo I., Williams M.G.L ., Dastidar A., Strange J.W. et al. CMR reclassifies the majority of patients with suspected MINOCA and non MINOCA. Eur. Heart J. Cardiovasc. Imaging. 2023; 25 (1): 8–15. DOI: 10.1093/ehjci/jead182
  27. Pasupathy S., Air T., Dreyer R.P., Tavella R., Beltrame J.F. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015; 131 (10): 861–870. DOI: 10.1161/CIRCULATIONAHA.114.011201
  28. Byrne R.A., Rossello X., Coughlan J.J., Barbato E., Berry C., Chieffo A. et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur. Heart J. 2023; 44 (38): 3720–3826. DOI: 10.1093/eurheartj/ehad191
  29. Armillotta M., Bergamaschi L., Amicone S., Sansonetti A., Stefanizzi A., Impellizzeri A. et al. Prognostic role of early cardiac magnetic resonance in myocardial infarction with non-obstructive coronary arteries. Eur. Heart J. 2022; 43 (Suppl. 2): ehac544.1459.
  30. Vicente-Ibarra N., Feliu E., Bertomeu-Martínez V., Cano-Vivar P., Carrillo-Sáez P., Morillas P., Ruiz-Nodar J.M. Role of cardiovascular magnetic resonance in the prognosis of patients with myocardial infarction with non-obstructive coronary arteries. J. Cardiovasc. Magn. Reson. 2021; 23 (1): 83. DOI: 10.1186/s12968-021-00773-w
  31. Bergamaschi L., Foà A., Paolisso P., Renzulli M., Angeli F., Fabrizio M. et al. Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries. JACC Cardiovasc. Imaging. 2024; 17 (2): 149–161. DOI: 10.1016/j.jcmg.2023.05.016.
  32. Boldyreva K.M., Aslanidis I.P., Shurupova I.V., Dorofeev A.V., Rychina I.E., Dzhandzhgava D.A. et al. Study of dynamic myocardial computed tomography perfusion quantitative indicators in patients with obstructive coronary artery disease. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (1): 71–84 (in Russ.). DOI: 10.24022/0236-2791-2024-66-1-71-84
  33. Petrosyan K.V., Abrosimov A.V., Goncharova E.S. Assessing coronary blood flow physiology in the modern strategy of coronary artery disease catheterization treatment. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2024; 66 (3): 270–281 (in Russ.). DOI: 10.24022/0236-2791-2024-66-3-270-281
  34. Golukhova E.Z., Shurupova I.V., Dorofeev A.V., Rychina I.E., Trifonova T.A., Boldyreva K.M. Characteristics of global myocardial blood flow and coronary reserve according to dynamic computed stress tomography in patients with coronary artery disease. Grudnaya i Serdechno- Sosudistaya Khirurgiya. 2024; 66 (5): 655–667 (in Russ.). DOI: 10.24022/0236-2791-2024-66-5-655-667
  35. Bergen T.A., Krestyaninov O.V., Ussov W.Yu., Badoian A.G., Khelimsky D.A., Tarkova A.R. et al. Predicting the effectiveness of left ventricular function recovery after recanalization of chronic coronary artery occlusion by magnetic resonance imaging. Grudnaya i Serdechno- Sosudistaya Khirurgiya. 2023; 65 (5): 549–562 (in Russ.). DOI: 10.24022/0236-2791-2023-65-5-549-562

About Authors

  • Bektur Sh. Berdibekov, Cand. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Svetlana A. Alexandrova, Cand. Med. Sci., Senior Researcher, Radiologist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Head of the Department of Coordination and Support of Scientific Research, Cardiologist; ORCID
  • Elena Z. Golukhova, Academician of the Russian Academy of Sciences, Dr. Med. Sci., Professor, Director; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by