Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis

Monney, Pierre; Sekhri, Neha; Burchell, Thomas; Knight, Charles; Davies, Ceri; Deaner, Andrew; Sheaf, Michael; Baithun, Suhail; Petersen, Steffen E.; Wragg, Andrew; Jain, Ajay; Westwood, Mark; Mills, Peter; Mathur, Anthony; Mohiddin, Saidi A.

doi:10.1136/hrt.2010.204818

Cited by 124 publications

(100 citation statements)

References 27 publications

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“…Высокая точность МРТ в большинстве опублико-ванных работ [6,12,13] обусловлена выборкой паци-ентов с острой формой миокардита в сочетании с высоким титром лабораторных маркеров поврежде-ния миокарда. В работах LT Jr. Cooper отмечено, что Lake Louise Criteria воспаления обладают высокой чувствительностью в течение первых двух недель от начала заболевания, а в более поздние сроки мар-керы воспаления (гиперемия и отек миокарда) могут не определяться [11].…”

Section: Discussionunclassified

Magnetic Resonance Imaging of the Heart in Diagnostics of Various Types of Myocarditis

Игнатьева¹,

Ryzhkova²,

Митрофанова³

et al. 2017

Russ J Cardiol

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Цель. Изучение лучевой семиотики различных клинико-морфологических форм миокардита с помощью магнитно-резонансной томографии (МРТ). Материал и методы. В исследование включены 70 больных с подозрением на миокардит по клинико-лабораторным данным (28 женщин и 42 мужчины; средний возраст -37,0±13,1 лет). Всем пациентам была выполнена эндомио-кардиальная биопсия (ЭМБ) и МРТ с внутривенным контрастированием. Чув-ствительность методики МРТ оценивалась относительно данных ЭМБ. Крите-рием исключения являлась сопутствующая ишемическая болезнь серд ца. Результаты. Из 70 пациентов с гистологически верифицированным миокар-дитом, только у 47 больных был установлен диагноз по результатам МРТ серд ца, чувствительность метода составила 67%. При остром активном и остром пограничном миокардитах отмечена высокая чувствительность МРТ -86%; при хроническом активном миокардите -74%, у пациентов с хро-ническим пограничным миокардитом -55%. Три МРТ-критерия миокардита с наибольшей частотой наблюдались при остром активном миокардите. Острый пограничный миокардит в большинстве случаев характеризовался сочетанием 2-х признаков: отека и позднего контрастного усиления. Значи-мым отличием активного миокардита от других клинико-морфологических форм является преобладание трансмурального паттерна позднего контрасти-рования. Также установлена сопряженность между активностью воспаления по данным ЭМБ и выраженностью отека миокарда (64,3% против 40,5%, р=0,005). Отличительным признаком хронического миокардита является слив-ной характер участков позднего контрастирования, которые превосходят по площади зоны отека сердечной мышцы. Заключение. Магнитно-резонансная томография сердца обладает наиболее высокой чувствительностью в выявлении острого миокардита, в случаях хро-нического миокардита чувствительность метода зависит от активности воспа-ления. Совпадение по площади участков позднего контрастирования и отека миокарда позволяют дифференцировать острый и хронический воспалитель-ный процесс в миокарде. Диагностика хронического пограничного миокар-дита невозможна без выполнения эндомиокардиальной биопсии. MAGNEtIC RESONANCE IMAGING OF tHE HEARt IN DIAGNOStICS OF VARIOUS tYPES OF MYOCARDItISIgnatieva E. S., Ryzhkova D. V., Mitrofanova L. B., Moiseeva O. M. Aim.To study the radiation semiotics of various clinical and morphological types of myocarditis with magnetic resonance imaging (MRI). Material and methods. Totally, 70 patients included, with suspected by clinical and lab data myocarditis (28 females, 42 males; mean age 37,0±13,1 y.o). All patients underwent endomyocardial biopsy (EMB) and MRI with intravenous contrasting. Sensitivity of MRI method was evaluated with relation to EMB. Exclusion criteria had been the comorbid ischemic heart disease. Results. Among 70 patients with histologically verified myocarditis, only 47 had this diagnosis by MRI data, sensitivity was set as 67%. In acute active and acute borderline myocardities there is high sensitivity of MRI -86%; in chronic active myocarditis -74%, in patients with chronic borderline myocardit...

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Section: Discussionunclassified

Magnetic Resonance Imaging of the Heart in Diagnostics of Various Types of Myocarditis

Игнатьева¹,

Ryzhkova²,

Митрофанова³

et al. 2017

Russ J Cardiol

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“…21,22 Cardiac MRI with the LGE technique has emerged as an important tool for the diagnostic workup of these patients, noninvasively distinguishing AM from ischemic injury and other nonischemic conditions with infarctlike presentation, such as Takotsubo cardiomyopathy. 7 Following a myocardial infarction, LGE with subendocardial or transmural pattern is typical. 7 Among patients with AM, LGE is typically epicardial, in the mid-wall, or patchy.…”

Section: Electrocardiography In Infarct-like Myocarditis and Relationmentioning

confidence: 99%

“…7 Following a myocardial infarction, LGE with subendocardial or transmural pattern is typical. 7 Among patients with AM, LGE is typically epicardial, in the mid-wall, or patchy. 7 Among patients with Takotsubo cardiomyopathy, which is characterized by a typical pattern of LV dysfunction, significant LGE is conversely usually absent.…”

Section: Electrocardiography In Infarct-like Myocarditis and Relationmentioning

confidence: 99%

“…7 Among patients with AM, LGE is typically epicardial, in the mid-wall, or patchy. 7 Among patients with Takotsubo cardiomyopathy, which is characterized by a typical pattern of LV dysfunction, significant LGE is conversely usually absent. 23,24 Electrocardiographic repolarization changes in infarctlike myocarditis have been described 5,25,26 ; STE, attributed to epicardial inflammatory injury, is followed by gradual STsegment normalization and subsequent variable occurrence of T-wave inversion, attributed to epicardial damage.…”

Section: Electrocardiography In Infarct-like Myocarditis and Relationmentioning

confidence: 99%

“…6 By accurately diagnosing the underlying cause of clinical presentation, cMRI may indeed facilitate appropriate treatment and follow-up. 7,8 In the setting of STE myocardial infarction (STEMI), previous cMRI studies have demonstrated a relation between some ECG features (including the sum of total STE [sumSTE], ST-segment resolution, residual STE, and the number of Q waves) with infarct size and extent of myocardium salvaged by reperfusion therapies. 9 -14 Conversely, scarce data are available regarding the clinical meaning of ECG changes in the setting of infarct-like myocarditis; accordingly, the purpose of this study was to explore the relation between the ECG findings in this group of patients and the extent of myocardial damage, as assessed by cMRI.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Infarct‐like Acute Myocarditis: Relation Between Electrocardiographic Findings and Myocardial Damage as Assessed by Cardiac Magnetic Resonance Imaging

Nucifora¹,

Miani²,

Chiara³

et al. 2012

Clinical Cardiology

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Background: Acute myocarditis (AM) may occasionally have an infarct-like presentation. The aim of the present study was to investigate the relation between electrocardiographic (ECG) findings in this group of patients and myocardial damage assessed by cardiac magnetic resonance imaging (MRI) with the late gadolinium enhancement (LGE) technique. Hypothesis: Myocardial damage may be associated with ECG changes in infarct-like AM. Methods: Forty-one consecutive patients (36 males; mean age, 36 ± 12 years) with diagnosis of AM according to cardiac MRI Lake Louise criteria and infarct-like presentation were included. The relation between site of ST-segment elevation (STE), sum of STE (sumSTE), time to normalization of STE, and development of negative T wave with the extent of LGE (expressed as % of left ventricular mass [%LV LGE]), was evaluated. Results: Most (80%) patients presented with inferolateral STE; mean sumSTE was 5 ± 3 mm. Normalization of STE occurred within 24 hours in 20 (49%) patients. Development of negative T wave occurred in 28 (68%) patients. Cardiac MRI showed LGE in all patients; mean %LV LGE was 9.6 ± 7.2%. Topographic agreement between site of STE and LGE was 68%. At multivariate analysis, sumSTE (β = 0.42, P < 0.001), normalization of STE >24 hours (β = 0.39, P < 0.001), and development of negative T wave (β = 0.49, P < 0.001) were independently related to %LV LGE. Conclusions: Analysis of the site of STE underestimates the extent of myocardial injury among patients with infarct-like myocarditis. However, some ECG features (ie, sumSTE, normalization of STE >24 hours, and development of negative T wave) may help to identify patients with larger areas of myocardial damage.

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Cardiovascular Magnetic Resonance Imaging: Overview of Clinical Applications in the Context of Cardiovascular CT

et al. 2016

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Acute myocarditis presenting as acute coronary syndrome: role of early cardiac magnetic resonance in its diagnosis

Abstract: Our study emphasises the importance of access to CMR for heart attack centres. If myocarditis is suspected, CMR scanning should be performed within 14 days. Myocarditis should not be regarded as benign, even when EF is preserved.

Cited by 124 publications

References 27 publications

Magnetic Resonance Imaging of the Heart in Diagnostics of Various Types of Myocarditis

Magnetic Resonance Imaging of the Heart in Diagnostics of Various Types of Myocarditis

Infarct‐like Acute Myocarditis: Relation Between Electrocardiographic Findings and Myocardial Damage as Assessed by Cardiac Magnetic Resonance Imaging

Cardiovascular Magnetic Resonance Imaging: Overview of Clinical Applications in the Context of Cardiovascular CT

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