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CTCA Limitations in Known CAD — EECC MCQ

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HardGeneral CardiologyCTCA Limitations in Known CADEECC

A 34-year-old has chest pain, troponin elevation and ventricular ectopy after a viral illness. Coronary CT excludes obstructive disease, echocardiography shows LVEF 48% and the patient is haemodynamically stable without sustained ventricular arrhythmia. Which investigation best provides non-invasive tissue phenotyping now?

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Correct answer: C — Perform cardiovascular magnetic resonance using oedema and non-ischaemic injury criteria

CMR is the principal non-invasive test for suspected myocarditis because it combines oedema-sensitive imaging, non-ischaemic injury or fibrosis patterns and ventricular assessment. FDG-PET is useful in selected inflammatory phenotypes such as suspected cardiac sarcoidosis but is not the routine first test here. Strain can quantify mechanics but cannot characterise inflammatory tissue. Endomyocardial biopsy is reserved for presentations in which histology will alter urgent management, and coronary OCT investigates occult coronary mechanisms rather than myocardial inflammation.

Reference: 2025 ESC Guidelines for myocarditis and pericarditis. https://academic.oup.com/eurheartj/article/46/40/3952/8234483