Key result
CMR serves as the noninvasive gold standard for diagnosing MINOCA by differentiating ischemic from non-ischemic causes.
Why the study?
MINOCA represents a diagnostic challenge that requires excluding non-ischemic causes, highlighting the need to explore the expanding role of CMR in diagnosing, reclassifying, and managing this condition.
CMR is highlighted as the noninvasive gold standard for diagnosing and managing MINOCA by differentiating ischemic from non-ischemic causes.
Supports CMR prioritization in MINOCA; leaves open prospective outcome trials before routine adoption.
INTRODUCTION: Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) represents a diagnostic challenge, requiring the exclusion of non-ischemic causes such as myocarditis, Takotsubo syndrome, and cardiomyopathies. Cardiac magnetic resonance (CMR) plays a pivotal role in differentiating MINOCA from these conditions by providing detailed tissue characterization to identify inflammation, edema, and fibrosis. This review explores the expanding role of CMR in diagnosing, reclassifying, and managing MINOCA, emphasizing its ability to guide treatment, improve prognosis, and aid risk stratification by identifying underlying causes. AREAS COVERED: This narrative review discusses recent advancements in CMR protocols for suspected MINOCA, its role in distinguishing ischemic from non-ischemic causes of acute myocardial injury, and its emerging utility in risk stratification and personalized therapy. Relevant articles were searched in PubMed, Scopus, and Cochrane databases up to February 2025. EXPERT OPINION: CMR is the noninvasive gold standard for diagnosing MINOCA. Its emerging role in evaluating coronary microcirculation, along with integrated approaches using coronary computed tomography, will further enhance the noninvasive assessment of MINOCA, in particular determining potential coronary and non-coronary etiologies.
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Leo et al. (2025) conducted a review in Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). Cardiac magnetic resonance (CMR) was evaluated. Cardiac magnetic resonance is the noninvasive gold standard for diagnosing MINOCA, providing detailed tissue characterization to differentiate ischemic from non-ischemic causes and guide management.
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