The role of multiparametric cardiac magnetic resonance in MINOCA and myocarditis: a single-center cohort study

Thursday, February 5, 2026

4:06 PM - 4:13 PM

Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

Presenting Author(s)

PP

Patrizia Pedrotti, MD

Cardiologist
ASST Grande Ospedale Metropolitano Niguarda
Milano, Lombardia, Italy

Primary Author(s)

CT

Chiara Tognola, MD

Cardiologist
ASST Grande Ospedale Metropolitano Niguarda, Italy

Co-Author(s)

SP

Stefano Pedroli

Fellow
ASST Grande Ospedale Metropolitano Niguarda, Italy
FD

Francesca Daus

Fellow
ASST Grande Ospedale Metropolitano Niguarda, Italy
DB

Davide Paolo Bernasconi

Statistics
University of Milan-Bicocca
Milano, Italy
PS

Paola Sormani, MD

Consultant Cardiologist
ASST Grande Ospedale Metropolitano Niguarda
Lecco, Lombardia, Italy
AM

Angela Milazzo, MD

Consultant Cardiologist
ASST Grande Ospedale Metropolitano Niguarda, Lombardia, Italy
GQ

Giuseppina Quattrocchi, MD

Consultant Cardiologist
ASST Grande Ospedale Metropolitano Niguarda, Lombardia, Italy
IB

Ilaria Bassi

Cardiologist
ASST Grande Ospedale Metropolitano Niguarda, Italy
CG

Cristina Giannattasio, MD, PhD

Full Professor of Cardiology
University of Milano Bicocca
Milano, Lombardia, Italy

Background:

Background: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous condition with diverse underlying pathophysiological mechanisms. Multiparametric cardiac magnetic resonance (CMR) has become a key diagnostic tool in this setting, allowing precise tissue characterization, the identification of alternative diagnosis, and prognostic assessment.
Evidence suggests that a considerable proportion of MINOCA cases are diagnosed with Acute Myocarditis (AM) following CMR. Conversely, an ischemic etiology may be identified by CMR in a non-negligible proportion of clinically suspected AM patients, thus suggesting an overlap between these two conditions.

Purpose: The objective of this study was to identify clinical and CMR features that differentiate MINOCA cases from AM cases, in order to establish a definitive diagnosis and allow for a tailored clinical strategy.

Methods: We conducted a comparison study between a cohort of 62 patients undergoing CMR in our Institution with a diagnosis of MINOCA (according to European Society of Cardiology (ESC) criteria) and a separate cohort of 65 patients undergoing CMR with clinically suspected AM. Both cohorts underwent the investigation between February 2021 and October 2024. CMR was acquired with a 1.5 T scanner and the protocol included SSFP cine images, STIR T2-w images, T1 and T2 mapping and late gadolinium enhancement (LGE). Patients were categorized based on their final CMR diagnosis. Medical history, clinical characteristics, ECG findings, echocardiographic data and CMR parameters were then compared across groups.

Results: The two cohorts exhibited significant differences in terms of clinical presentation and CMR features (Tables 1 and 2). Patients in the MINOCA group were older, more frequently female and showed a higher prevalence of hypertension and dyslipidemia. Furthermore, they exhibited a higher prevalence of wall motion abnormalities and less extensive, localized LGE with ischemic distribution.

In contrast, the AM group consisted mostly of younger male patients with an "infarct-like" presentation and higher troponin peak levels. Wall motion abnormalities were less prevalent, and LGE was more extensive, patchy and with non-ischaemic distribution.

Conclusion: CMR has a crucial role in the differential diagnosis between MINOCA and AM. Its diagnostic yield is increased when a careful patient selection, supported by a strong clinical suspicion, guides the diagnostic pathway.

Table 1. Clinical characteristics of the study population

Variables	MINOCA N=62	Acute Myocarditis N=65	p
Age (median [IQR])	59.45 [49.88, 75.18]	29.71 [23.31, 40.04]	< 0.001
Sex F (%)	40 (64.5)	12 (18.5)	< 0.001
BSA (median [IQR])	1.74 [1.60, 1.90]	1.90 [1.76, 2.03]	0.003
BMI (median [IQR])	24.00 [22.42, 27.04]	24.22 [22.22, 27.12]	0.95
Hypertension (%)	34 (54.8)	7 (11.1)	< 0.001
Active smoke (%)	17 (27.4)	27 (42.9)	0.105
Dyslipidaemia (%)	28 (45.2)	4 (6.3)	< 0.001
Diabetes (%)	3 (4.8)	0 (0.0)	0.237
Familiarity for CAD (%)	19 (30.6)	18 (28.6)	0.954
Thoracic pain (%)	49 (79.0)	59 (93.7)	0.034
Dyspnoea (%)	9 (14.5)	7 (11.1)	0.763
ST segment elevation (%)	13 (21.0)	34 (56.7)	< 0.001
ST segment depression (%)	11 (17.7)	6 (10.0)	0.331
TWI (%)	28 (45.2)	14 (23.3)	0.019
Q wave (%)	11 (17.7)	0 (0.0)	0.002
AV block 1 (%)	1 (1.6)	1 (1.7)	1
MVA (%)	1 (1.6)	4 (6.7)	0.342
Troponin peak (median [IQR])	270.50 [74.25, 536.00]	544.00 [207.50, 1283.50]	< 0.001
CKMB peak (median [IQR])	7.30 [3.85,.65]	34.00 [12.90, 79.40]	< 0.001
CRP peak (median [IQR])	0.30 [0.10, 1.30]	8.00 [3.92, 18.00]	< 0.001

List of abbreviations: F = female; BSA = body surface area; BMI = body mass index; CAD = coronary artery disease; STE = ST elevation; NSTE = non-ST elevation; TWI = T wave inversion; MVA = malignant ventricular arrhythmias; TnT = troponin T; CKMB = creatine kinase-MB; CRP = C-reactive protein.Table 2.

Variables	MINOCA N=62	Acute Myocarditis N=65	p
LVEF (median [IQR])	63.00 [59.00, 67.75]	61.00 [54.00, 64.00]	0.074
Wall Motion Abnormalities (%)	45 ( 72.6)	26 ( 40.0)	< 0.001
Pericardial effusion (%)	19 ( 30.6)	38 ( 58.5)	0.003
T1 mapping pre (median [IQR])	1060.00 [1013.00, 1151.00]	1066.00 [1023.00, 1124.00]	0.949
ECV (median [IQR])	0.27 [0.24, 0.32]	0.27 [0.24, 0.32]	0.797
T2 mapping (median [IQR])	55.00 [45.00, 60.00]	52.00 [48.00, 55.25]	0.31
Edema (%)	48 ( 78.7)	54 ( 83.1)	0.689
LGE (%)	48 ( 81.4)	58 ( 93.5)	0.079
LGE pattern (%)			< 0.001
Non ischemic	21 ( 43.8)	49 ( 92.5)
Both (ischemic and non ischemic)	10 ( 20.8)	3 ( 5.7)
Ischemic	17 ( 35.4)	1 ( 1.9)

List of abbreviations: LVEF = Left Ventricular Ejection Fraction; ECV = Extracellular Volume, LGE = Late Gadolinium EnhancementProportion of patients exhibiting LGE
Proportion of patients exhibiting edema