Cardiac CT with Late Iodine Enhancement Refines Working Diagnosis in Acute Troponin Elevation without AMI

In patients with acute chest pain, elevated troponin, no AMI, CCTA+LIE/ECV modified working diagnosis in 48% (91/191) and showed high agreement with discharge diagnosis (0.94). At 24 months, no MACE in CT-negative patients.

• CCTA identified obstructive CAD in 40% of patients; among CCTA-negative cases, LIE/ECV detected myocarditis (30%), Takotsubo (13%), amyloidosis (3%), and dilated cardiomyopathy (1%).
• The combined CT protocol provided an etiologic diagnosis in 75% of patients and demonstrated strong agreement with final discharge diagnosis (0.94).
• No major adverse cardiovascular events occurred in patients with negative CCTA+LIE/ECV over median 24-month follow-up.

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