To understand the definition of troponin-positive nonobstructive coronary arteries (TPNOCA) and myocardial infarction with nonobstructive coronary arteries (MINOCA)
To identify CT findings of various causes of TPNOCA and MINOCA
Elevated cardiac troponin in serum is a sensitive and specific marker for the presence of myocardial injury. However, underlying etiology of myocardial injury still remains unclear with elevated troponin alone. Identification of underlying etiology in troponin positive patients with acute chest pain is paramount of importance as various entities with heterogenous prognosis result in this condition. In clinical practice, positive troponin patients accompanied by chest pain or ECG changes are often investigated with coronary angiography as a standard downstream test. As a problem-solving tool, Cardiac...
Findings and procedure details
Definition of TPNOCA and MINOCA
Radiologists should understand the conceptual difference between acute myocardial injury and myocardial infarction (AMI). Acute myocardial injury indicates rise and fall of cardiac troponin in serum within two weeks. Persistent or prolonged elevation of cardiac troponin (i.e., more than two weeks) can occur in chronic ongoing myocardial injury in various diseases such as dilated cardiomyopathy, various heart failure, and hypertrophic cardiomyopathy. As the elevation of cardiac troponin is chronic myocardial injury in these conditions, these should not be included in...
Cardiac CT has a potential to narrow down differential diagnosis of TPNOCA, and to help to guide specific downstream testing.
Personal information and conflict of interest
S. M. Yoo; Bundang/KR - nothing to disclose
Pathik B, Raman B, Mohd Amin NH, Mahadavan D, Rajendran S, McGavigan AD, Grover S, Smith E, Mazhar J, Bridgman C, Ganesan AN, Selvanayagam JB. Troponin-positive chest pain with unobstructed coronary arteries: incremental diagnostic value of cardiovascular magnetic resonance imaging. Eur Heart J Cardiovasc Imaging. 2016 Oct;17(10):1146-52. doi: 10.1093/ehjci/jev289. Epub 2015 Nov 20.
Scalone G, Niccoli G, Crea F. Editor's Choice- Pathophysiology, diagnosis and management of MINOCA: an update. Eur Heart J Acute Cardiovasc Care. 2019 Feb;8(1):54-62.
Yoo SM, Chun EJ, Lee HY, Min D....