February 8, 2026European Heart Journal
How late is too late? Influence of CMR timing in suspected MINOCA
Key result
Early CMR for MINOCA yields a ~76% diagnosis rate that steadily declines with delayed imaging.
Why the study?
Time-sensitive conditions like myocarditis or Takotsubo syndrome may become undetectable if CMR is delayed, making scan timing crucial to optimize diagnostic yield in suspected MINOCA.
Does the timing of CMR affect the diagnostic yield in patients presenting with suspected MINOCA?
Population
888 consecutive patients presenting with ACS and nonobstructed coronary arteries
Comparison
CMR scan timing across different time intervals after acute presentation
Design
Registry-based observational study
Authors
Discussion
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Member takes
Implication
Early CMR may maximize MINOCA diagnostic yield; supports consensus on timely imaging but leaves open prospective trials.
Key Points
- The aim is to evaluate how scan timing of CMR affects diagnostic performance in suspected MINOCA cases.
- Patients from a local MINOCA CMR Registry were included for analysis.
- Subjects underwent comprehensive CMR examinations within a standardized protocol.
- Diagnostic groups included various conditions such as myocarditis and Takotsubo syndrome.
- Logistic regression and restricted cubic splines analyzed the relationship between scan timing and diagnosis.
- CMR identified underlying causes in 75.68% of the 888 patients studied.
- Diagnostic yield peaked within 7 days post-acute presentation, declining 1% daily thereafter.
- Detection rate for Takotsubo syndrome decreased significantly after the first week, dropping to 6% after 3 months.
Structured PICO
Does the timing of CMR affect the diagnostic yield in patients presenting with suspected MINOCA?
P
Population
888 consecutive patients presenting with acute coronary syndrome (ACS) and nonobstructed coronary arteries (suspected MINOCA), 51% females.
I
Intervention
1.5-T Cardiovascular magnetic resonance imaging (CMR) performed at various time intervals after acute presentation.
C
Comparator
Comparison across different time intervals from acute presentation to CMR scan.
O
Outcome
Diagnostic yield (proportion of non-normal CMR studies out of all CMR studies performed).surrogate
Performing CMR within 15 days of acute presentation in suspected MINOCA optimizes diagnostic yield, particularly for time-sensitive conditions like Takotsubo syndrome.
Cite This Study
Bisaccia et al. (2025) studied this question. Performing CMR within 15 days of ACS with nonobstructed arteries yields 76% diagnosis rate, declining 1% daily after 7 days; Takotsubo detection drops from 24% to 6% after 3 months.