Abstract
In 5-15% of cases of acute coronary syndromes, patients present with myocardial infarction with non-obstructed coronary arteries, or MINOCA. Cardiac Magnetic Resonance (CMR) imaging can provide comprehensive and accurate diagnosis, differentiating multiple pathologies that may mimic MINOCA. In this thesis, we present findings from a large, single- centre registry of patients referred for CMR with suspected MINOCA.In Chapter 2, we explore the clinical predictors and risk stratification of suspected MINOCA. Increased age, positive smoking history, increased length of hospital stays, impaired left ventricular ejection fraction, and a CMR diagnosis of cardiomyopathy were independent risk factors for mortality. Chapter 3 highlights the pivotal role CMR plays in differentiating suspected MINOCA, re-classifying the working diagnosis in 77.8% of patients - the majority of diagnoses being non-MINOCA diagnoses. The implications of correct diagnosis and how CMR is utilised in clinical decision-making are further explored in Chapter 4. Whilst CMR can positively influence diagnosis and improve clinical decision making, there are still areas of improvement in the management of patients with suspected MINOCA, particularly with respect to secondary prevention medication. The impact of the COVID-19 pandemic in presentations of suspected MINOCA is studied in Chapter 5. We have demonstrated a rise in Takotsubo syndrome post national lockdowns, which may reflect the psychosocial impact of the global pandemic. In addition, there was no significant rise in myocarditis or infarctions despite initial concern related to both COVID-19 and the roll-out of vaccinations.
This thesis provides several new insights into how CMR is currently integrated into the management of suspected MINOCA and myocardial injuries. Importantly, we have shown the ongoing role of CMR in defining underlying aetiology, allowing personalised and prognostically relevant treatment in these patients. CMR within clinical practice and guidelines continues to evolve but it remains increasingly valuable in this cohort of patients.
| Date of Award | 9 Dec 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Chiara Bucciarelli-Ducci (Supervisor), Thomas W Johnson (Supervisor) & Eva Sammut (Supervisor) |