This clinical study examines patients presenting with acute myocardial infarction and no significant coronary artery disease on coronary angiography (MINOCA) and patients with MINOCA-mimics with advanced CMR.

The present study aims to:

• assess the microvascular function with a novel quantitative 3D myocardial perfusion imaging approach in the acute phase and post-convalescence
• refine the role and diagnostic potential of advanced quantitative CMR imaging
• assess the potential prognostic significance of microvascular dysfunction and epicardial adipose tissue on cardiovascular outcomes

Participants will undergo advanced CMR imaging in the acute setting (within 10 days after event) and post convalescence (after 3 months).

Advanced CMR includes a novel free-breathing motion-informed locally low-rank quantitative 3D myocardial perfusion imaging. Perfusion imaging will be compared with 3D late gadolinium enhancement (LGE) imaging. A cine Dixon sequence is performed for the assessment of epicardial adipose tissue (EAT).

Inclusion Criteria:

• acute presentation with signs/symptoms of acute coronary syndrome or myocarditis
• elevated cardiac biomarkers
• no signficant coronary artery disease on coronary angiogram or coronary CT

Exclusion Criteria:

• pacemaker/other devices or claustrophobia
• severe asthma, chronic obstructive lung or kidney disease
• acute pulmonary embolism
• arrhythmia on ECG
• moderate to severe valvular disease