A new study led by researchers at Wake Forest University School of Medicine suggests that cardiac magnetic resonance imaging (MRI) can play a valuable role in assessing patients with chest pain and mildly elevated troponin levels.
Troponin, a protein, increases in response to heart muscle damage due to a heart attack. The study’s findings were published online in Circulation: Cardiovascular Imaging.
Context and Concerns
Around three million patients visit emergency departments each year with chest pain and mildly elevated troponin levels, but how best to evaluate them remains uncertain.
“Patients who present to the emergency room with chest pain and mildly elevated troponin often fall into a diagnostic gray zone,” said Chad Miller, M.D., professor and chair of emergency medicine at Wake Forest University School of Medicine.
The Study
The research involved randomizing 312 participants at four U.S. sites to either undergo cardiac MRI or more invasive-based interventions.
The researchers followed the participants for 2.8 years, documenting heart attacks, deaths, and cardiac-related hospital readmission or emergency visits.
Results and Implications
The study found no significant differences in clinical or safety event rates between the two pathways. However, the team noted that using cardiac MRI reduced the need for invasive angiography over the long-term follow-up period.
In the cardiac MRI group, 58% of participants were safely discharged based on negative imaging and did not require angiography or an intervention, such as revascularization, within 90 days.
“These findings confirm that cardiac MRI is a highly accurate test that can be reliably used as first-line testing in this complex patient population,” said Dr. Miller.
These results could have significant implications for the management of patients with chest pain and mildly elevated troponin, offering a less invasive and effective diagnostic approach.
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The study was published in Circulation Cardiovascular Imaging.
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