The role of CMR in the evaluation of microvascular coronary dysfunction and in the diagnosis of other causes of MINOCA in patients with NSTEMI.


  • DIKUSAR Olga IMSP Institutul de Cardiologie
  • DARII Olga 3Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии им. А.Н. Бакулева» Министерства здравоохранения Российской Федерации
  • POPOVICI Ion Spitalul Polivalent NovaMed
  • MUNTEANU Mihaela IMSP Institutul de Cardiologie
  • CIOBANU Lucia Spitalul Polivalent NovaMed
  • IVANOV Victoria IMSP Institutul de Cardiologie
  • POPOVICI Mihail IMSP Institutul de Cardiologie



acute myocardial infarction, NSTEMI-MINOCA, CMR


Myocardial infarction without coronary artery obstruction (MINOCA) is 3 times more common in patients with NSTEMI compared to STEMI. The potential etiology of MINOCA can be divided in coronary and non-coronary causes. At the same time, an important role in its etiopathogenesis is played by microvascular coronary dysfunction (DCM). The aim of the study is to assess the feasibility of cardiac magnetic resonance (CMR) as a non-invasive method of evaluating DCM in patients with NSTEMI and in addition, to verify the substrate of MINOCA according to CMR. A diagnostic examination was carried out in 16 patients, of which coronary etiology was confirmed only in 1/3, the rest of the patients had a non-coronary etiology of the disease (myocarditis, hypertrophic cardiomyopathy and dilated cardiomyopathy). Microvascular coronary dysfunction (CDM) was determined in 30% of patients with non-coronary impairment (group I) and in 50% of those with coronary heart disease (group II) (χ² = 0.64, p> 0.05). Significant differences between groups were observed in the localization of fibrosis, so in group II, according to CMR, all patients had subendocardial fibrosis - 100%, while in group I, intramural fibrosis prevailed in 50% (n = 5), subepicardial fibrosis - 20% (n = 2) and in 20% (n = 2) both types of contrast enhancement were noted, χ² = 12.44 p < 0.05. In conclusion, CMR is an important diagnostic tool both in assessing the causes of MINOCA and in evaluating DCM in this category of patients. However, further studies are needed to improve the diagnostic accuracy of this method in the study of coronary microcirculation.


Abdu F.A.; Liu L.; Mohammed A.Q.; Luo Y.; Xu S.; Auckle R.; Xu Y.; Che W. Myocardial infarction with non-obstructive coronary arteries (MINOCA)in Chinese patients: Clinical features, treatment and 1 year follow-up. International Journal of Cardiology, 2019; 287:27–31.

Agewall S.; Beltrame J.F.; Reynolds H.R.; Niessner A.; Rosano G.; Caforio A.L.P.; De Caterina R.; Zimarino M.; Roffi M.; Kjeldsen K.; Atar D.; Kaski J.C.; Sechtem U.; and Tornvall P. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. European Heart Journal, 2017, 38(3):143–153.

Agewall S.; Giannitsis E.; Jernberg T.; Katus H. Troponin elevation in coronary vs. non-coronary disease. European Heart Journal, 2011, 32 (4):404–411.

Camici P.G.; Tschöpe C.; Di Carli M.F.; Rimoldi O.; Van Linthout, S. Coronary microvascular dysfunction in hypertrophy and heart failure. Cardiovascular Research, 2020; 116, 4, 806–816.

Collet J.P.; Thiele H.; Barbato E.; Bauersachs J.; Dendale P.; Edvardsen T.; Gale C.P.; Jobs A.; Lambrinou E.; Mehilli J.; Merkely B.; Roffi M.; Sibbing D.; Kastrati A.; et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, 2021; 42(14):1289–1367.

Dastidar A.G.; Baritussio A.; De Garate E.; Drobni Z.; Biglino G.; Singhal P.; Milano E.G.; Angelini G.D.; Dorman S.; Strange J.; Johnson T.; Bucciarelli-Ducci C. Prognostic Role of CMR and Conventional Risk Factors in Myocardial Infarction With Nonobstructed Coronary Arteries. JACC: Cardiovascular Imaging, 2019; 12(10):1973–1982.

Laguens R.; Alvarez P.; Vigliano C.; Cabeza Meckert P.; Favaloro L.; Diez M.; Favaloro R. Coronary microcirculation remodeling in patients with idiopathic dilated cardiomyopathy. Cardiology, 2011; 119(4):191–196.

Ong P.; Camici P.G.; Beltrame J.F.; Crea F.; Shimokawa H.; Sechtem U.; Kaski J.C.; Bairey Merz C.N.International standardization of diagnostic criteria for microvascular angina. International Journal of Cardiology, 2018 250:16–20.

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):61–870.

Patel A.R.; Epstein F.H.; Kramer C.M. Evaluation of the microcirculation: Advances in cardiac magnetic resonance perfusion imaging. Journal of Nuclear Cardiology, 2008; 15 (5): 698–708.

Pathik B.; Raman B.; Hanim Mohd Amin N.; Mahadavan D.; Rajendran S.; McGavigan A.D.; Grover S.; Smith E.; Mazhar J.; Bridgman C.; Ganesan A.N.; Selvanayagam J.B. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging.European Heart Journal – Cardiovascular Imaging, 2016; 17:1146–1152.

Planer D.; Mehran, R. Ohman, E.M. White, H.D. Newman, J.D. Xu, K.; Stone G.W. Prognosis of patients with non-ST-segment-elevation myocardial infarction and nonobstructive coronary artery disease: Propensity-matched analysis from the acute catheterization and urgent intervention triage strategy trial. Circulation: Cardiovascular Interventions, 2014; 7 (3):285–293.

Plugaru A.; Ivanov M.; Ivanov V.; Popovici I.; Ciobanu L.; Dicusar O.; Popovici M. Preliminary data from the retrospective and prospective observational studies on NSTEMI patient management in Moldova. The Moldovan Medical Journal, 2021; 64 (1):56-62.

Rakowski T., De Luca G., Siudak Z., Plens K., Dziewierz A., Kleczyński P., Tokarek T., Węgiel M., Sadowski M., Dudek D. Characteristics of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA) in Poland: data from the ORPKI national registry. Journal of Thrombosis and Thrombolysis, 2019; 47 (3):462–466.

Safdar B.; Spatz E.S.; Dreyer R.P.; Beltrame J.F.; Lichtman J.H.; Spertus J.A.; Reynolds H.R.; Geda M.; Bueno H.; Dziura J.D.; Krumholz H.M.; D’Onofrio G. Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): Results from the VIRGO study. Journal of the American Heart Association, 2018; 7 (13).

Shamsi F.; Hasan K.Y.; Hashmani S.; Jamal S.F.; Ellaham S. Review Article--Clinical Overview of Myocardial Infarction Without Obstructive Coronary Artey Disease (MINOCA). Journal of the Saudi Heart Association, 2021; 33 (1): 9.

Tamis-Holland J.E.; Jneid H.; Reynolds H.R.; Agewall S.; Brilakis E.S.; Brown T.M.; Lerman A.; Cushman M.; Kumbhani D.J.; Arslanian-Engoren C.; Bolger A.F.; Beltrame J.F. 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.

Trifunovic D.; Dudic, J. Coronary microcirculation – from basic research to cardiac magnetic resonance (CMR), imaging – part I. J Hypertens Res., 2019; 5(1):8–20.





Research Article