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MODERN ASPECTS OF MAGNETIC RESONANCE
TOMOGRAPHY IN MYOCARDIAL INFARCTION
Aripov Dilshodbek Murodilloevich
https://orcid.org/ 0009-0004-1840-0819
Bukhara State Medical Institute named after Abu Ali ibn Sino,
Uzbekistan, Bukhara.
Abstract
According to current clinical guidelines, cardiac magnetic resonance
imaging (MRI) is recommended as a key study in the diagnostic algorithm for
myocardial infarction, since it allows excluding diseases such as myocarditis,
takotsubo syndrome and cardiomyopathy, and also provides visual confirmation of
myocardial necrosis. In addition, data are accumulating that support the prognostic
value of MRI for this group of patients. This literature review discusses the diagnostic
role of MRI in patients with myocardial infarction.
Keywords
: myocardial infarction, magnetic resonance imaging, pathogenesis,
epidemiology.
СОВРЕМЕННЫЕ АСПЕКТЫ МАГНИТНО-РЕЗОНАНСНОЙ
ТОМОГРАФИИ ПРИ ИНФАРКТЕ МИОКАРДА
Арипов Дилшодбек Муродиллоевич
https://orcid.org/ 0009-0004-1840-0819
Бухарский государственный медицинский институт
имени Абу Али ибн Сино, Узбекистан, г. Бухара.
Аннотация
Согласно текущим клиническим рекомендациям, магнитно-
резонансная томография (МРТ)сердца рекомендуется как ключевое
исследование в алгоритме диагностики инфаркт миокарда, так как она позволяет
исключить такие заболевания, как миокардит, синдром такоцубо и
кардиомиопатии, а также предоставляет визуальное подтверждение
миокардиального
некроза.
Кроме
того,
накапливаются
данные,
поддерживающие прогностическую ценность МРТ для этой группы пациентов.
Это литературный обзор посвящен обсуждению диагностической роли МРТ у
пациентов с инфаркт миокарда.
Ключевые слова
: инфаркт миокарда, магнитно-резонансная томография,
патогенез, эпидемиология.
MIOKARD INFARKTIDA MAGNIT-REZONANS TOMOGRAFIYA
TEKSHIRUVINING ZAMONAVIY ASPEKTLARI
Aripov Dilshodbek Murodilloevich
https://orcid.org/ 0009-0004-1840-0819
Abu Ali ibn Sino nomidagi Buxoro davlat tibbiyot instituti, O‘zbekiston, Buxoro.
Annotatsiya
Mavjud klinik ko'rsatmalarga ko'ra, yurak magnit-rezonans
tomografiyasi (MRT) miokard infarkti diagnostikasi algoritmida asosiy tadqiqot
sifatida tavsiya etiladi, chunki u miyokardit, takotsubo sindromi va kardiyomiyopatiya
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kabi kasalliklarni istisno qilishga imkon beradi, shuningdek, miokard nekrozini vizual
tasdiqlash imkonini beradi. Bundan tashqari, ushbu bemorlar guruhi uchun MRTning
prognostik qiymatini tasdiqlovchi ma'lumotlar to'planmoqda. Ushbu adabiyotlar
sharhida miyokard infarkti bo'lgan bemorlarda MRT diagnostik roli muhokama
qilinadi.
Kalit so'zlar:
miokard infarkti, magnit-rezonans tomografiya, patogenez,
epidemiologiya.
Relevance of the research
Non-obstructive myocardial infarction (NOMI) is
characterized by the absence of hemodynamically significant stenoses (< 50%) of the
coronary arteries (CA) during angiography in patients with myocardial infarction (MI)
[1]. The prevalence of Non-obstructive myocardial infarction is 5–6% among patients
diagnosed with myocardial infarction; it is higher among women and among patients
with non-ST-segment elevation MI (NSTEMI) compared to patients with ST-segment
elevation MI (STEMI) [2]. In 2017, the EOC proposed for the first time criteria for the
diagnosis of myocardial infarction, which included: 1) verified myocardial infarction,
according to the third universal definition; 2) absence of stenosis ≥ 50% of the coronary
artery; and 3) absence of another clinically obvious specific cause that could serve as
an alternative cause of the acute condition. However, this definition was too broad and
included a heterogeneous spectrum of etiologic factors, some of which are not directly
related to the development of ischemia [3]. In this regard, in the updated fourth
definition of myocardial infarction, structural myocardial changes and extracardiac
pathology causing an increase in troponin levels (e.g., myocarditis or pulmonary
embolism - PE) are considered separately from myocardial infarction and are
designated as "an increase in troponin without coronary artery obstruction".
Accordingly, to make a final diagnosis of myocardial infarction, it is necessary to
exclude: 1) obvious extracardiac causes of an increase in troponin (e.g., sepsis, PE); 2)
ischemic heart disease (IHD) involving small-diameter epicardial vessels (e.g.,
complete occlusion of a small segment or significant stenosis of the distal branch of
the coronary artery ≥ 50%); 3) non-ischemic mechanisms of myocardial injury that
mimic MI (e.g., myocarditis, takotsubo syndrome) [2].
According to current clinical guidelines, cardiac magnetic resonance imaging
(MRI) is recommended as a key study in the diagnostic algorithm for myocardial
infarction, since it can exclude myocarditis, takotsubo syndrome, and cardiomyopathy,
and provide imaging confirmation of myocardial necrosis [2, 4, 5]. Currently, more
and more data are accumulating indicating the prognostic role of MRI in this category
of patients. In rare cases, myocardial infarction may be complicated by the
development of left ventricular (LV) maneuvers, LV thrombosis, or life-threatening
ventricular arrhythmias [6]. This descriptive review is devoted to the discussion of the
diagnostic and prognostic role of MRI in patients with myocardial infarction.
Numerous studies have confirmed that MRI contributes to an accurate diagnosis in
patients with myocardial infarction in 30–90% of cases [7].
Moreover, the time of MRI after the initial symptoms is a determining factor in
the diagnostic accuracy of MRI in cases of suspected myocardial infarction. MRI
performed within 2 weeks from the initial manifestation of symptoms is associated
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with the highest probability of identifying the underlying etiology of myocardial
damage in these patients [8]. Recent reports from foreign researchers show that earlier
MRI, less than 14 days after the onset of symptoms, improves the diagnostic value
from 72 to 94% when combined with a peak increase in troponin > 211 ng/L [8].
As noted, in patients with suspected myocardial infarction, MRI can exclude
myocarditis, Takotsubo syndrome, and nonischemic cardiomyopathies. It is generally
accepted that MRI examination in patients with myocardial infarction should be
performed optimally within 7 days of symptom onset to prevent false-negative results
or underestimation of the extent of the disease [9]. The MRI examination protocol for
the evaluation of patients with myocardial infarction should include assessment of
cardiac structure and function using cine imaging, the presence and nature of
cardioedema using T2-weighted imaging (T2w-STIR), and the presence and nature of
myocardial injury using late gadolinium enhancement (LGE). In addition, it is
recommended to use new methods of tissue characterization, such as T1 mapping with
extracellular volume (ECV) assessment. According to MRI data, zones of late
gadolinium accumulation in subendocardial or transmural localization indicate
ischemic genesis of myocardial damage, while its subepicardial or intramyocardial
localization can be caused by non-ischemic causes, such as myocarditis or
cardiomyopathy [9]. Acute myocarditis is an inflammatory disease of the myocardium,
characterized by an extremely diverse etiology [10]. Diagnosis of myocarditis remains
a difficult task even at this stage of development of modern medicine due to the
heterogeneity of clinical manifestations and the absence of specific signs of clinical,
laboratory and traditional instrumental research methods [10].
Despite the fact that endomyocardial biopsy is considered the "gold standard" for
diagnosing myocarditis, cardiac MRI is the key diagnostic method for this condition.
In 2018, the MRI criteria for diagnosing myocardial inflammation "Lake-Louise
Criteria 2018" were updated [11], according to which the main MRI criterion for acute
myocarditis is the presence of myocardial edema (on T2-weighted images or T2
mapping) and the presence of signs of non-ischemic myocardial damage (increased
native T1 and extracellular volume (ECV) or the presence of LGE). Additional criteria
include the presence of pericardial effusion and systolic dysfunction of the LV
(impaired regional or global contractility of the LV). Cardiac MRI plays a key role in
the initial diagnosis of myocardial infarction, as has been noted above, but at the
moment more and more data are accumulating indicating the prognostic role of MRI
in this category of patients. In the work of M. Armillotta et al., 175 patients with
myocardial infarction were included in the final analysis [12].
According to the MRI results, patients with myocardial infarction were classified
into two phenotypes: LGE-positive phenotype (ischemic subendocardial or transmural
LGE pattern) or LGE-negative (cases without LGE, but with regional myocardial
damage determined by myocardial edema in the coronary blood supply zone with a
typically ischemic “wave front” and/or regional wall motion abnormality consistent
with coronary blood supply). A total of 121 (69.1%) patients were found to have areas
of delayed gadolinium accumulation (LGE “+” group). The mean follow-up period was
36.1±15.2 months, and MRI was performed on average 6 ± 2.9 days after the acute
onset of symptoms. During the follow-up, HF (15.7% vs. 1.9%, p = 0.008) and MACE
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(20.7% vs. 7.4%, p = 0.029) occurred statistically significantly more frequently in the
LGE “+” group of patients compared with the LGE “–” group. A prospective
multicenter study by N. Vicente-Ibarra et al. included 120 consecutive patients with
MRI-confirmed myocardial infarction [13]. During the three-year follow-up period, 43
(35.8%) patients developed MACE in the form of death, nonfatal MI, stroke, or
rehospitalization. According to multivariate analysis, involvement of three or more LV
myocardial segments (LGE) almost tripled the risk of MACE.
In a recent study, L. Bergamaschi et al. assessed the prognostic role of MRI in
myocardial infarction [14]. The study included 437 patients with myocardial infarction
who were divided into three subgroups according to the phenotype detected by MRI:
1) the presence of delayed gadolinium enhancement (LGE) zones and abnormal
myocardial mapping (M-mapping) indices (LGE+/M+); 2) regional ischemic
myocardial injury with abnormal mapping indices and without LGE (LGE–/M+); and
3) the absence of pathological MRI indices (LGE–/M–). The primary endpoint was the
development of major adverse cardiovascular events (MACE). The mean follow-up
period was 33.7±12.0 months, and MRI was performed on average 4.8±1.5 days after
the acute manifestation. The final cohort included 198 patients with myocardial
infarction; 116 (58.6%) formed the LGE+/M+ group. During follow-up, MACE
occurred significantly more frequently in the LGE+/M+MI subgroups than in the
LGE+/M– and LGE–/M– subgroups (20.7% versus 6.7 and 2.7%, respectively; p =
0.006). According to multivariate Cox regression analysis, the degree of LV fibrosis
(% LGE) was an independent predictor of MACE along with T2 mapping values. Thus,
at present, more and more data are accumulating, indicating the prognostic role of MRI
in the group of patients with myocardial infarction. Conclusion Cardiac MRI plays a
key role in the initial differential diagnosis of myocardial infarction, in addition, at
present, more and more data are accumulating, confirming the prognostic role of MRI
in this category of patients [15]. Further studies using T1 mapping techniques are
needed for differential diagnosis and determining the prognosis in patients with
myocardial infarction.
List of references:
1
.
Шерашов А.В., Шилова А.С., Першина Е.С., Щекочихин Д.Ю., Свет А.В.,
Гиляров М.Ю. Инфаркт миокарда без признаков обструктивного атеросклероза
коронарных артерий. Кардиология. 2020; 60 (3): 89–95.
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):891–908.
3. Рябов В.В., Федорова С.Б., Вышлов Е.В. Инфаркт миокарда без
обструктивного коронарного атеросклероза – актуальная проблема неотложной
кардиологии. Сибирский журнал клинической и экспериментальной медицины.
2018; 33 (4): 10–18.
4. Голухова Е.З., Александрова С.А., Булаева Н.И., Мрикаев Д.В., Громова
О.И., Бердибеков Б.Ш. Прогностическая роль показателей деформации миокарда
по
данным
магнитно-резонансной
томографии
при
неишемических
дилатационных кардиомиопатиях: систематический обзор и мета-анализ.
JOURNAL OF NEW CENTURY INNOVATIONS
Volume–81_Issue-1_July-2025
124
124
Кардиология. 2022; 62 (10): 35–41.
5. Воробьева Д.А., Лугачева Ю.Г., Капилевич Н.А., Рябов В.В.
Сравнительный анализ протромботической активности у пациентов с инфарктом
миокарда при необструктивном и обструктивном поражениях коронарных
артерий. Российский кардиологический журнал. 2021; 26 (2): 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):13995.
7. 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 using3T cardiac MRI. Radiol. Med. 2017; 122 (2): 106–112.
8. 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.
9. 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.
10. Schultheiss H.P., Kühl U., Cooper L.T. The management of myocarditis. Eur.
Heart J. 2011; 32 (21): 2616–2625.
11. Ferreira V.M., Schulz-Menger J., Holmvang G., Kramer C.M., Carbone I.,
Sechtem U. et al. Cardiovascular magnetic resonance in nonischemic myocardial
inflammation: expert recommendations. J. Am. Coll. Cardiol. 2018; 72 (24): 3158–
3176.
12. 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):
544.1459.
13. 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.
14. 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.
15. Болдырева К.М., Асланиди И.П., Шурупова И.В., Дорофеев А.В.,
Рычина И.Е., Джанджгава Д.А. и др. Информативность количественных
показателей кровотока по данным динамической компьютерной томографии при
идентификации обструктивного поражения коронарного русла. Грудная и
сердечно-сосудистая хирургия. 2024; 66 (1): 71–84.
