CMR in MINOCA Linked to Improved Diagnosis and Management
In a prospective study of over 300 patients with myocardial infarction with nonobstructive coronary arteries (MINOCA), cardiovascular magnetic resonance (CMR) was associated with meaningful changes in clinical diagnosis and/or management in 63% of patients and a similar increase in diagnostic certainty.
METHODOLOGY:
Previous CMR studies in MINOCA have focused on radiologic yield — a limited metric that does not reflect real‐world clinical utility. Prospective data on patient care are lacking.
This prospective study conducted in Australia and the UK assessed the impact of CMR on diagnosis and management in 320 patients with MINOCA (mean age, 55.6 years; 52% men) recruited between January 2019 and July 2023.
Patients were included if they had a hospital admission with acute features consistent with the Fourth Universal Definition of Myocardial Infarction, no obstructive coronary artery disease on angiography, and a clinician assessment indicating acute myocardial infarction as the most likely presentation.
The treating cardiologists completed a questionnaire before and after CMR to record their working diagnosis, rate diagnostic certainty on a 1-10 scale (10 = most certain), and specify intended management, including medications and follow-up testing.
The primary endpoint was a composite of change in clinical diagnosis or management after CMR.
TAKEAWAY:
CMR was associated with a change in diagnosis or management in 63% of patients (P < .001), with diagnosis revised in 38% and management changed in 50%.
Diagnostic certainty increased significantly from a median score of 6-8 after CMR (P < .001), and diagnostic confidence numerically increased in 63% of patients.
The absence of coronary atheroma, a pre-CMR diagnostic certainty score ≤ 5, and early CMR (performed within 14 days of hospital presentation) independently predicted a change in diagnosis or management, with 80% of patients with all three predictors vs 40% of those with none meeting the primary outcome.
Of 172 patients initially prescribed dual antiplatelet therapy, 66 (38%) had it deprescribed following CMR, yielding a number needed to test of 3.
IN PRACTICE:
'Integration of CMR into diagnostic imaging pathways may be reasonable to augment clinical diagnosis and management; however, further cost-effectiveness analyses are now warranted,' the study authors wrote.
SOURCE:
This study was led by Adil Rajwani, PhD, of the Royal Perth Hospital, Perth, Australia. It was published online on June 13, 2025, in Heart.
LIMITATIONS:
The study was limited by the impracticality of conducting a bias-free randomized trial of CMR vs no CMR. It was also limited by the assessment of CMR's impact only immediately after imaging, potentially missing later clinical insights. Medication protocols were not standardized, and the limited use of additional diagnostics such as optical coherence tomography may have influenced the findings.
DISCLOSURES:
This study was funded by a grant from the Royal Perth Hospital Medical Research Foundation in Australia. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
33 minutes ago
- Medscape
5 Fast Facts: Plant Extracts Relieve Hand Osteoarthritis
If you have patients with hand osteoarthritis (OA) who want extra relief and don't mind trying a plant-based supplement, this combo looks promising. Researchers in Belgium found that a daily combination of plant extracts significantly reduced hand OA pain over time. 1. Patients had real pain relief. People with hand OA who took Curcuma longa (turmeric) and Boswellia serrata had noticeably better pain reduction over 3 months than those on placebo, about 8-9 points better on the pain scale. 2. Quality of life received a boost, too. Patients didn't just feel less pain; they also reported feeling better overall and rated their quality of life higher than the placebo group. 3. Safe and easy to stick with. Patients took the supplement consistently (over 90% adhered to it), and side effects were comparable to those of the placebo. 4. Well-done study — but with a few limits. This solid randomized, double-blind, placebo-controlled trial focused on patient-reported outcomes rather than structural improvements or radiographic findings. 5. Another option for the toolbox. These extracts aren't a replacement for standard care, but they may be a safe adjunct for patients wanting complementary therapies for hand OA pain, especially those who prefer more 'natural' options. Bottom line: Current evidence indicates that plant extracts provide symptomatic relief for hand OA; however, they do not address the underlying joint pathology. Counsel patients on these limitations.
Yahoo
38 minutes ago
- Yahoo
Right-to-Die Activist Ends Life by Starving Herself to ‘Protect My Children From Seeing Me Choke and Struggle to Breathe'
Two years ago, Emma Bray, 42, was diagnosed with a terminal neurological condition called motor neuron disease She decided to end her life by starving herself, hoping to spare her children from witnessing her decline any further The mom of two announced her own death on Instagram on July 14 alongside a final photo of herself lying in a hospice bedA British mother made the tough decision to starve herself to death to spare her children from witnessing the devastating effects of her terminal neurological condition. Two years ago, Emma Bray from Barnstaple, England, was diagnosed with motor neuron disease (MND). MND is a group of neurological disorders that gradually destroy the motor neurons, according to the Cleveland Clinic. These nerve cells are found in the brain and spinal cord, and they control muscle movement for activities like breathing, speaking, swallowing and walking. ALS — also known as Lou Gehrig's disease — is the most common MND. Never miss a story — sign up for to stay up-to-date on the best of what PEOPLE has to offer, from celebrity news to compelling human interest stories. 'I've had four different health professionals tell me I've got the worst disease possible,' she told The Mirror in May, using an eye-gazing machine to speak. 'I now feel I am at the stage where my quality of life is very affected, I can no longer use any of my limbs. My talking is severely affected, and I struggle to eat, and it's getting harder to breathe. I am only really comfortable in bed, and social visits are exhausting.' 'I have carers multiple times a day, can't be left alone overnight and can no longer do any basic tasks,' the 42-year-old continued. 'I can't scratch an itch, push up my glasses, or move a bed sheet if I am too hot or cold. I feel like I am losing the essence of me. I am still so loved, but I can't be myself, and I see that grief on everyone's faces." is now available in the Apple App Store! Download it now for the most binge-worthy celeb content, exclusive video clips, astrology updates and more! Bray — who actively campaigned for Dignity in Dying — was an advocate for the Assisted Dying Bill, which would allow adults in the UK who are terminally ill to have the choice of medical aid in dying. She said, if it were passed, it would've prevented her loved ones suffering for two years with anticipatory grief. 'Imagine seeing your children crying and upset and not be able to hug them or curl up in bed and wipe their tears away,' she told the outlet, referring to her children, age 15 and 14. 'This is hands down the thing I hate the most about motor neurone disease. It's taken my children's mum from them little by little.' So, Bray decided to end her life using the 'voluntarily stopping eating or drinking' practice, also known as VSED. According to nonprofit Compassion & Choices — which provides resources, training and support for those navigating end-of-life health care — VSED is 'when a mentally capable individual decides to control their own dying by making a conscious decision to refuse foods and fluids of any kind.' 'VSED is not an easy death, but with the current law in England, this is the only way I can have control over my death,' Bray explained. 'I want to protect my children from seeing me choke and struggle to breathe. I don't want to die, but I am going to and have come to terms with my impending death, and I know I want to die surrounded by loved ones, music and laughter, not in an emergency way after further decline.' 'My last bit of parenting I can do is to limit the suffering and trauma they have to witness,' she added. 'I made a promise to myself that I wanted to wait to see my daughter finish high school and my son grow up a little so I can picture the man he will become.' ! In her final months, she told the outlet that she's urging members of parliament to help others 'die with peace.' On Monday, July 14, Bray — from her @stupid_mnd account — posted on Instagram, announcing her own death alongside a final photo of herself lying in a hospice bed overlooking the trees. 'If you are reading this then I've finished my final spin round the sun,' she wrote. 'I've lived a very good life, surrounded by love, music and laughter and I want this to continue in my memory. Rather than shed a tear (or whilst you do) please plant a tree or call a friend, do a random act of kindness or take time to watch a sunset. For moments of doubt please ask 'what would Emma do?' and run with that probably inappropriate answer.' 'Hug everyone a little tighter and love openly,' she ended. 'Please surround those who were closest to me with love, time and patience. And to quote Frank Turner - Remember you get to dance another day but now you have to dance for one more of us. Love you , bye.' Read the original article on People
Forbes
an hour ago
- Forbes
Neil Armstrong Recalls The Final Stages Of Apollo 11's Moon Landing
Former astronaut Neil Armstrong testified before the Senate Appropriations Committee on supersonic transport. He showed a film of the first Russian made Soviet TU-144. Bettmann Archive In 2011, just a year prior to his death, Neil Armstrong gave a rare public account of his final few thousand feet of descent in the Lunar Module July 20, 1969. It was before the House Science Committee with other space dignitaries present, including Apollo 17's Gene Cernan. In typical Armstrong fashion, the account is factual and understated, without much emotion. Accompanying his humble narration were actual images taken from the LM juxtaposed with the same images enhanced by newer Google Moon Map technology. The Google images allowed the audience to more accurately see what Armstrong saw from the windows of his spacecraft. Following are edited excerpts from what he said. Neil Armstrong: 'I was informed by a gentleman in Australia of an interesting film that has been created in the United States that I did not know about, using Google Moon to enhance the photos that Apollo 11 took on the way down to the lunar surface. I'm going to show it now. The actual descent of the Lunar Module took twelve-and-a-half minutes, but I'll describe the last three-and-a-half starting at about 3,000 feet in altitude, and then continuing all the way down.. APRIL 18, 2006: Former astronaut Neil Armstrong receives the NASA Ambassadors of Exploration award in Cincinnati, Ohio. (Photo by Bill Ingalls/NASA via Getty Images) NASA via Getty Images We were descending at a controlled rate, but with many computer warnings, sounding, which we were getting used to by then. The autopilot told us it was going to land us close to the rim of a large crater I could see. I didn't want to go there. It had steep sides and a broad field of large boulders about the size of automobiles. I looked out about a mile further to the west, where there looked to be a smooth and level landing spot. We saw another crater coming up, about 30 meters or a hundred feet in size, but, beyond it, those level spots that looked good. We were running low on fuel, though, because we'd extended our flight forward. With about 30 seconds left, we were getting very close to the surface, and could see dust kicking up. We could also see the shadow of our lander leg as it touched down. Then Buzz [Aldrin] said, 'Engine stop,' and the Eagle was down! From left: US Vice President Dan Quayle, US President George HW Bush (1924-2018), and astronauts Neil Armstrong (1930-2012), Buzz Aldrin (born Edwin Aldrin Jr), and Michael Collins (1930-2021) with NASA's Lunar Module 2 at the National Air and Space Museum, Washington DC, July 20. (Photo by Robert Trippett/Pool) Getty Images What you see on-screen now is one of the actual vertical pictures taken of the spot where we landed - plus the descent stage of Eagle that contained the rocket engine we'd used for descent and the fuel for that engine, the landing legs and some of the scientific equipment we left behind on the moon. It's a view into history with the help of modern technology.'
