087 THE USEFULNESS OF EARLY CARDIOVASCULAR MAGNETIC RESONANCE IN PATIENTS PRESENTING WITH ACUTE CHEST PAIN, POSITIVE TROPONIN AND NON-OBSTRUCTIVE CORONARY ARTERIES
Bibliographic record
Abstract
Introduction Patients presenting with chest pain, raised troponin but non-obstructive coronary arteries pose a clinical challenge in diagnosis, prognosis and management. We hypothesised that early cardiovascular magnetic resonance (CMR) imaging can provide a diagnosis and comprehensive characterisation for acute myocardial injury of indeterminate aetiology. Methods and results 120 patients presenting with chest pain, positive troponin (TnI>0.04 µg/l) and non-obstructive coronary arteries prospectively underwent early CMR (median 3 days, range 0–14 days) at 1.5 T, including cine imaging for function, T2-weighted imaging for oedema and late gadolinium enhancement (LGE) imaging for myocardial necrosis/scarring. The mean age=50±17 years (50% female); median TnI=3.99 ug/l (0.07–60 µg/l); mean left ventricular ejection fraction=64±12%. There was a high CMR diagnostic yield of 95%. Significant oedema was detected in 79% and LGE in 61%. The commonest diagnosis was myocarditis (37.5%), followed by Takotsubo cardiomyopathy (22.5%), myocardial infarction (17.5%), acute regional stunning (9.2%; wall motion abnormality with oedema but no LGE), dilated cardiomyopathy (4.2%), hypertrophic cardiomyopathy (3.3%), and missed pulmonary embolism (0.8%). Eleven of the 21 patients with MI (52%) had a patent foramen ovale (PFO) demonstrated on transthoracic echocardiography with agitated saline contrast and presumably suffered a paradoxical embolism to a coronary artery. The remaining 5.0% of patients had no clear diagnosis identified. Conclusions CMR has a high diagnostic yield (95%) in patients presenting with troponin-positive chest pain but non-obstructive coronary arteries when performed early (median 3 days). This study highlights the importance and usefulness of early access to CMR in this group of patients. When no apparent cause is identified, early conventional CMR was able to exclude myocardial infarction, wall motion abnormality, significant oedema or scarring.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".