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Case Reports
. 2023 Feb 1:7:101722.
doi: 10.1016/j.jaccas.2022.101722.

Fingerprinting MINOCA: Unraveling Clues With Quantitative CMR

Saberio Lo Presti  1 , Brendan L Eck  2 , Reza Reyaldeen  1 , Christopher Nguyen  1   2   3 , W H Wilson Tang  1 , Scott D Flamm  1   2 , Nicole Seiberlich  4 , Gastao Lima da Cruz  4   5 , Claudia Prieto  5   6 , Deborah H Kwon  1   2
Affiliations
Case Reports

Fingerprinting MINOCA: Unraveling Clues With Quantitative CMR

Saberio Lo Presti et al. JACC Case Rep. .

Abstract

In the following case series, we describe the clinical presentation of 2 patients with myocardial infarction with nonobstructive coronary arteries with different underlying pathophysiologic mechanisms. In both scenarios, cardiac magnetic resonance (CMR) imaging provided comprehensive tissue characterization with both conventional parametric mapping techniques and CMR fingerprinting. These cases demonstrate the diagnostic utility for CMR to elucidate the underlying etiology and appropriate therapeutic strategy. (Level of Difficulty: Advanced.).

Keywords: CAD, coronary artery disease; CMR, cardiac magnetic resonance; ECV, extracellular volume; GRASE, gradient and spin echo sequence; LGE, late gadolinium enhancement; MI, myocardial infarction; MINOCA; MINOCA, myocardial infarction with nonobstructive coronary arteries; OCT, optical coherence tomography; cMRF, cardiac magnetic resonance fingerprint; cardiac magnetic fingerprinting; cardiac magnetic resonance.

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Conflict of interest statement

This work was supported through a Philips research agreement with the Cleveland Clinic and a grant from the National Institutes of Health National Institute on Aging (identification K25 AGO70321). Dr Kwon has research agreements with Circle Cardiovascular Imaging, and Myocardial Solutions. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Accelerated Images Are Reconstructed and Coil-Combined to Produce a Time Series of Image Data The cardiac magnetic resonance fingerprint (cMRF) signal for a voxel (yellow box) is measured and compared to a dictionary of signal evolutions for different tissue properties (eg, T1, T2) to find the best match by maximizing the inner product. This procedure is repeated for each voxel to obtain T1, T2, and M0 maps. Units: T1 and T2: milliseconds; M0: arbitrary units (a.u.).
Figure 2
Figure 2
Patient 1 Tissue Analysis (Upper row) MOLLI pre- and post-CA–generated T1 and ECV maps demonstrating abnormal values in the midinferolateral segment (region of interest 2, arrow) as well as GRASE sequence T2-generated maps with normal values. (Lower row) cMRF T1- and ECV-generated maps with similar findings compared with conventional techniques. CA = contrast administration; cMRF = cardiac magnetic resonance fingerprint; ECV = extracellular volume; GRASE = gradient and spin echo sequence; MOLLI = modified Look-Locker inversion recover sequence.
Figure 3
Figure 3
Patient 1 (A) Echocardiographic peak longitudinal strain demonstrating low GLS (-13.4%). Note that radial and circumferential strain could not be assessed because of poor echocardiographic windows. (B) Peak radial, circumferential, and longitudinal strain polar maps obtained by 3-dimensional cardiac magnetic resonance. AHA = American Heart Association; GLS = global longitudinal strain.
Figure 4
Figure 4
Patient 2 Tissue Analysis (Upper row) MOLLI pre- and post-CA–generated T1 and ECV maps demonstrating abnormal values in the midanterolateral segment (region of interest 2, arrow) as well as GRASE sequence T2-generated map consistent with increased edema (region of interest 2). (Lower row) cMRF T1-, ECV-, and T2-generated maps with similar findings compared with conventional techniques. Abbreviations as in Figure 2.
Figure 5
Figure 5
Patient 2 (A) Echocardiographic peak longitudinal strain demonstrating low GLS (-15.4%). Note that the radial and circumferential strain could not be assessed because of poor echocardiographic windows. (B) Peak radial, circumferential, and longitudinal strain polar maps obtained by 3-dimensional CMR. AHA = American Heart Association; ANT = anterior; GS = global strain; INF = inferior; LAT = lateral; POST = posterior; SEPT = septal.
Figure 6
Figure 6
Flowchart of the Diagnosis and Management of Patients With MINOCA CAD = coronary artery disease; CFR = coronary flow reserve; ECV = extracellular volume; EKG = electrocardiogram; FFR = fractional flow reserve; iFR = instantaneous wave-free ratio; IVUS = intravascular ultrasound; LGE = late gadolinium enhancement; MINOCA = myocardial infarction with nonobstructive coronary arteries; MR = magnetic resonance; MRI = magnetic resonance imaging; OCT = optical coherence tomography.
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