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Comparative Study
. 2008 Apr 30;10(1):19.
doi: 10.1186/1532-429X-10-19.

Relation between myocardial edema and myocardial mass during the acute and convalescent phase of myocarditis--a CMR study

Anja Zagrosek  1 , Ralf Wassmuth, Hassan Abdel-Aty, André Rudolph, Rainer Dietz, Jeanette Schulz-Menger
Affiliations
Comparative Study

Relation between myocardial edema and myocardial mass during the acute and convalescent phase of myocarditis--a CMR study

Anja Zagrosek et al. J Cardiovasc Magn Reson. .

Abstract

Background: Myocardial edema is a substantial feature of the inflammatory response in human myocarditis. The relation between myocardial edema and myocardial mass in the course of healing myocarditis has not been systematically investigated. We hypothesised that the resolution of myocardial edema as visualised by T2-weighted cardiovascular magnetic resonance (CMR) is associated with a decrease of myocardial mass in steady state free precession (SSFP)-cine imaging.

Methods: 21 patients with acute myocarditis underwent CMR shortly after onset of symptoms and 1 year later. For visualization of edema, a T2-weighted breath-hold black-blood triple-inversion fast spin echo technique was applied and the ratio of signal intensity of myocardium/skeletal muscle was assessed. Left ventricular (LV) mass, volumes and function were quantified from biplane cine steady state free precession images. 11 healthy volunteers served as a control group for interstudy reproducibility of LV mass.

Results: In patients with myocarditis, a significant decrease in LV mass was observed during follow-up compared to the acute phase (156.7 +/- 30.6 g vs. 140.3 +/- 28.3 g, p < 0.0001). The reduction of LV mass paralleled the normalization of initially increased myocardial signal intensity on T2-weighted images (2.4 +/- 0.4 vs. 1.68 +/- 0.3, p < 0.0001). In controls, the interstudy difference of LV mass was lower than in patients (5.1 +/- 2.9 g vs. 16.3 +/- 14.2 g, p = 0.02) resulting in a lower coefficient of variability (2.1 vs 8.9%, p = 0.04).

Conclusion: Reversible abnormalities in T2-weighted CMR are paralleled by a transient increase in left ventricular mass during the course of myocarditis. Myocardial edema may be a common pathway explaining these findings.

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Figures

Figure 1
Figure 1
CMR images in the acute (left) and convalescent (right) phase of myocarditis. Upper left: SSFP-cine images showing increased LV mass compared to follow-up (upper right). Lower left: T2-weighted STIR images with higher signal intensity of myocardium compared to follow-up (lower right). [SSFP: steady-state free precession].
Figure 2
Figure 2
LV mass in cine-CMR in the acute and convalescent phase (follow-up) of myocarditis (dotted line: mean values of LV mass).
See this image and copyright information in PMC

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