Cardiovascular Magnetic Resonance in MINOCA and Acute Myocarditis: A Comparative Multiparametric Evaluation

Q: What are the key findings of this study?

Multiparametric CMR identified late gadolinium enhancement in 50.0% of suspected MINOCA patients vs 93.8% of acute myocarditis patients (p<0.001) and reclassified 41.9% of MINOCA diagnoses.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected myocardial infarction with non-obstructive coronary arteries (MINOCA) and suspected acute myocarditis (AM) (n=127). Intervention: Suspected MINOCA vs. Suspected acute myocarditis. Primary outcome: Presence of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (p=<0.001).

Q: What does this research mean for the field?

Multiparametric cardiovascular magnetic resonance distinguishes ischemic from inflammatory injury by revealing late gadolinium enhancement in 50.0% of suspected MINOCA patients compared to 93.8% of acute myocarditis patients, reclassifying 41.9% of MINOCA cases. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chiara Tognola; Francesca Daus; Stefano Pedroli; Davide Paolo Bernasconi; Paola Sormani; Ilaria Bassi; Angela Milazzo; Giuseppina Quattrocchi; Cristina Giannattasio; Patrizia Pedrotti

doi:10.1007/s10554-026-03819-1

October 23, 2026The International Journal of Cardiovascular ImagingOpen Access

Cardiovascular Magnetic Resonance in MINOCA and Acute Myocarditis: A Comparative Multiparametric Evaluation

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Key result

Multiparametric CMR reclassifies ~42% of suspected MINOCA cases, detecting LGE in half of patients.

P<0.001
n=127

Why the study?

Myocardial infarction with non-obstructive coronary arteries (MINOCA) and acute myocarditis (AM) often present with overlapping clinical features and biomarker profiles, making early differential diagnosis challenging. This study aimed to compare clinical and CMR characteristics of patients with suspected MINOCA and AM to identify imaging features enabling accurate differentiation.

Does multiparametric cardiovascular magnetic resonance (CMR) reliably differentiate ischemic from inflammatory myocardial injury and refine the initial clinical diagnosis in patients presenting with suspected MINOCA and suspected acute myocarditis?

Study Design

Type

Cohort (n=127)

Multicenter

No

Structured PICO

Does multiparametric cardiovascular magnetic resonance (CMR) reliably differentiate ischemic from inflammatory myocardial injury and refine the initial clinical diagnosis in patients presenting with suspected MINOCA and suspected acute myocarditis?

P

Population

127 consecutive patients (40.9% female) with suspected MINOCA (n=62, median age 59 years) or suspected acute myocarditis (n=65, median age 30 years) undergoing CMR within 14 days of symptom onset.

E

Exposure

Standardized multiparametric 1.5T cardiovascular magnetic resonance (CMR) evaluation performed within 14 days of symptom onset (median 7 days in MINOCA group, 6 days in AM group), including balanced SSFP cine imaging, T2W-STIR, native and post-contrast T1 and T2 mapping, extracellular volume (ECV) quantification, and late gadolinium enhancement (LGE) imaging 10 minutes after intravenous gadobutrol (0.15 mmol/kg).

C

Comparator

Comparison between patients referred with an initial clinical working diagnosis of suspected MINOCA (n=62) versus suspected acute myocarditis (n=65), and comparison of CMR-based final diagnosis against initial pre-CMR clinical working diagnosis.

O

Outcome

CMR tissue characterization features (presence, pattern, and distribution of LGE, native T1, native T2, and ECV) and diagnostic reclassification of the initial working diagnosis.surrogate

Main Result

Absolute Event Rate: 50% vs 93.8%

p-value: p=<0.001

Early multiparametric CMR reliably differentiates ischemic from inflammatory myocardial injury primarily via LGE patterns rather than isolated T1/T2 mapping values, reclassifying over 40% of patients initially diagnosed with MINOCA and directly guiding tailored medical therapy.

Limitations

Retrospective single-center design and relatively small sample size
CMR imaging timing was not fully standardized across all patients
First-pass perfusion imaging was not systematically available
Intracoronary imaging and functional coronary assessment were not routinely performed to characterize exact ischemic mechanisms
Formal inter- and intra-observer reproducibility analyses were not performed
Relatively short follow-up duration and low number of clinical events prevented meaningful prognostic evaluation

Implication

Supports CMR differentiation of suspected MINOCA from myocarditis; leaves open whether routine use improves outcomes.

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) and acute myocarditis (AM) often present with overlapping clinical features and biomarker profiles, making early differential diagnosis challenging. Cardiovascular magnetic resonance (CMR) is the reference modality for etiological assessment through functional evaluation and multiparametric tissue characterization. The aim of this study was to compare clinical and CMR characteristics of patients with MINOCA and suspected AM, and to identify imaging features enabling accurate differentiation. We retrospectively analyzed 127 consecutive patients undergoing CMR (February 2021–October 2024): 62 with suspected MINOCA and 65 with suspected AM. Clinical data, laboratory findings, ECG, and CMR parameters (cine imaging, T1/T2 mapping, extracellular volume [ECV], and late gadolinium enhancement [LGE]) were assessed. MINOCA patients were older (median 59 years) and predominantly female (64.5%), whereas AM patients were younger (median 29 years) and mainly male (81.5%). AM was associated with higher troponin and inflammatory markers. Among patients initially referred with suspected MINOCA, LGE was present in 50.0%, compared with 93.8% of those referred with suspected acute myocarditis ( p < 0.001). MINOCA showed predominantly ischemic LGE patterns, while AM exhibited non-ischemic subepicardial or mid-wall LGE with myocardial edema. CMR confirmed myocardial infarction in 48.4% of patients and identified alternative diagnoses in 41.9%, while 9.7% had normal CMR findings. Multiparametric CMR reliably distinguishes ischemic from inflammatory myocardial injury in patients with chest pain, elevated troponin, and non-obstructive coronaries. Early CMR integration improves diagnostic accuracy and supports tailored management.

Discussion

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Cite This Study

Tognola et al. (2026) conducted a cohort in Suspected myocardial infarction with non-obstructive coronary arteries (MINOCA) and suspected acute myocarditis (AM) (n=127). Suspected MINOCA vs. Suspected acute myocarditis was evaluated on Presence of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (p=<0.001). Multiparametric CMR identified late gadolinium enhancement in 50.0% of suspected MINOCA patients vs 93.8% of acute myocarditis patients (p<0.001) and reclassified 41.9% of MINOCA diagnoses.

synapsesocial.com/papers/6adc966ca704d151585a5e43 https://doi.org/10.1007/s10554-026-03819-1

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Cardiovascular Magnetic Resonance in MINOCA and Acute Myocarditis: A Comparative Multiparametric Evaluation

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiovascular Magnetic Resonance in MINOCA and Acute Myocarditis: A Comparative Multiparametric Evaluation

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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