TY - JOUR
T1 - Utility of cardiovascular magnetic resonance in patients with stable troponin elevation
AU - Ananthakrishna, Rajiv
AU - Rajvi, Benita P.
AU - Hancock, Diana E.
AU - Kholmurodova, Feruza
AU - Woodman, Richard J.
AU - Patil, Sanjana
AU - Horsfall, Matthew
AU - Chew, Derek P.
AU - Daril, Noor Darinah Mohd
AU - Selvanayagam, Joseph B.
PY - 2023/2
Y1 - 2023/2
N2 - 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.
AB - 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.
KW - cardiovascular magnetic resonance
KW - diagnosis
KW - stable troponin elevation
UR - http://www.scopus.com/inward/record.url?scp=85147046361&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jeac215
DO - 10.1093/ehjci/jeac215
M3 - Article
C2 - 36336838
AN - SCOPUS:85147046361
SN - 2047-2404
VL - 24
SP - 192
EP - 201
JO - European heart journal. Cardiovascular Imaging
JF - European heart journal. Cardiovascular Imaging
IS - 2
ER -