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. 2012 Feb;28(2):327-35.
doi: 10.1007/s10554-011-9812-7. Epub 2011 Feb 24.

Cardiac magnetic resonance visualizes acute and chronic myocardial injuries in myocarditis

Knut Haakon Stensaeth  1 , Pavel Hoffmann, Eigil Fossum, Arild Mangschau, Leiv Sandvik, Nils Einar Klow
Affiliations

Cardiac magnetic resonance visualizes acute and chronic myocardial injuries in myocarditis

Knut Haakon Stensaeth et al. Int J Cardiovasc Imaging. 2012 Feb.

Abstract

Our objective was to evaluate the ability of CMR to visualize myocardial injuries over the course of myocarditis. We studied 42 patients (39 males, 3 females; age 37 ± 14 years) with myocarditis during the acute phase and after 12 ± 9 months. CMR included function analyses, T2-weighted imaging (T2 ratio), T1-weighted imaging before and after i.v. gadolinium injection (global relative enhancement; gRE), and late gadolinium enhancement (LGE). In the acute phase, the T2 ratio was elevated in 57%, gRE in 31%, and LGE was present in 64% of the patients. In 32 patients (76%) were any two (or more) out of three sequences abnormal. At follow-up, there was an increase in ejection fraction (57.4 ± 11.9% vs. 61.4 ± 7.6; P < 0.05) while both T2 ratio (2.04 ± 0.32 vs. 1.70 ± 0.28; P < 0.001) and gRE (4.07 ± 1.63 vs. 3.11 ± 1.22; P < 0.05) significantly decreased. The LGE persisted in 10 patients. Dilated cardiomyopathy was present in 3 patients and 4 patients received a defibrillator or a pacemaker. A comprehensive CMR approach is a useful tool to visualize myocardial tissue injuries over the course of myocarditis. CMR may help to differentiate acute from healed myocarditis, and add information for the differential diagnoses.

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Figures

Fig. 1
Fig. 1
Patient with myocarditis (a–l). CMR demonstrates T2-weighted (a, b, g, h), gRE (c, d, i, j), and LGE (e, f, k, l) during the acute phase (top) and follow-up (bottom). During the acute phase, lateral intramural signal elevation is seen in all images (white arrows). At follow-up, the T2 changes are not seen, but gRE and LGE lesions persisted (spotty appearance; white arrows/circles)
Fig. 2
Fig. 2
Line graphs demonstrate the changes in ejection fraction (EF), gRE, and T2 ratios over the course of myocarditis. The increased EF (P < 0.05) is paralleled by a normalization of gRE (P < 0.05) and T2 ratio (P < 0.001)
Fig. 3
Fig. 3
CMR demonstrates a patient with DCM (a–h). EF is 19% and EDV 348 ml (a; end-diastole, b; end-systole). The T2-weighted (c, d) and gRE (e, f) images are normal, but there is lateral epicardial LGE (g, h; white arrows). This patient had later an ICD implanted and no follow-up CMR was done
See this image and copyright information in PMC

References

    1. Feldman AM, McNamara D. Myocarditis. N Engl J Med. 2000;343:1388–1398. doi: 10.1056/NEJM200011093431908. - DOI - PubMed
    1. Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians. Med J Aust. 2004;180:110–112. - PubMed
    1. Kawai C. From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future. Circulation. 1999;99:1091–1100. - PubMed
    1. Calabrese F, Basso C, Carturan E, Valente M, Thiene G. Arrhythmogenic right ventricular cardiomyopathy/dysplasia: is there a role for viruses? Cardiovasc Pathol. 2006;15:11–17. doi: 10.1016/j.carpath.2005.10.004. - DOI - PubMed
    1. Masoudi FA, Magid DJ, Vinson DR, Tricomi AJ, Lyons EE, Crounse L, Ho PM, Peterson PN, Rumsfeld JS. Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction: results of the Emergency Department Quality in Myocardial Infarction (EDQMI) study. Circulation. 2006;114:1565–1571. doi: 10.1161/CIRCULATIONAHA.106.623652. - DOI - PubMed

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