Key result
Multimodality imaging in MINOCA improves diagnostic accuracy and identifies underlying etiology to guide targeted therapy.
Why the study?
MINOCA is a complex syndrome with variable mechanisms and substantial morbidity, and the evolving role of multimodality cardiovascular imaging in clarifying etiology and guiding therapy needed summarization.
A structured multimodality imaging approach is essential for unraveling the heterogeneous etiologies of MINOCA, thereby enabling etiology-specific management and prognostic assessment.
Supports multimodality imaging to refine MINOCA diagnosis; leaves open whether targeted therapy improves outcomes in randomized trials.
MI with non-obstructive coronary arteries (MINOCA) represents a complex, heterogeneous syndrome with variable underlying mechanisms and substantial morbidity. The role of multimodality cardiovascular imaging in clarifying etiology and guiding therapy continues to evolve. Multimodality imaging offers insights into the pathophysiology of MINOCA. Coronary angiography remains the first-line diagnostic tool to exclude obstructive coronary disease, while adjunctive functional testing can identify epicardial or microvascular vasospasm. Echocardiography evaluates ventricular function, wall motion abnormalities, and embolic sources, whereas cardiac MRI differentiates ischemic from non-ischemic injury, detects myocardial edema, and assesses scar burden. Intravascular imaging can detect plaque rupture, erosion, or thrombus. Nuclear imaging modalities provide a quantitative assessment of microvascular perfusion and coronary flow reserve. Coronary CT angiography may further characterize non-obstructive plaque or coronary anomalies. This review summarizes the comprehensive evaluation of MINOCA. Integrating modalities can improve diagnostic accuracy, identify the underlying etiology, guide targeted therapy, and inform prognosis, underscoring the importance of a multimodal imaging approach.
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Diaz et al. (2026) conducted a review in Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA). Multimodality cardiovascular imaging was evaluated. Integrating multimodality cardiovascular imaging in the evaluation of MINOCA improves diagnostic accuracy, identifies the underlying etiology, and guides targeted mechanism-specific therapy.
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