Cardiovascular Magnetic Resonance in Myocarditis

Polte, Christian L.; Bobbio, Emanuele; Bollano, Entela; Bergh, Niklas; Polte, Christina; Himmelman, Jakob; Lagerstrand, Kerstin; Gao, Sinsia A.

doi:10.3390/diagnostics12020399

Cited by 32 publications

(22 citation statements)

References 126 publications

(221 reference statements)

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“…The AUCs of LGE and T 2 showed the best discrimination of both groups with an LGE extent > 2.8% of LV myocardial mass and T 2 > 51 ms. This might be explained by a decrease of inflammation from the acute to the subacute phase [ 42 ]. T 1 mapping has proven to be a sensitive marker for myocardial disease of different entities [ 33 , 43 ], but seems limited for discrimination of acute from chronic processes [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis

Brendel

Klingel

Kübler

et al. 2022

JCM

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(1) Background: Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. (2) Objectives: To systematically evaluate non-invasive CMR imaging parameters in acute and subacute myocarditis. (3) Methods: 48 patients (age 37 (IQR 28–55) years; 52% female) with clinically suspected myocarditis were consecutively included. Patients with onset of symptoms ≤2 weeks prior to 1.5T CMR were assigned to the acute group (n = 25, 52%), patients with symptom duration >2 to 6 weeks were assigned to the subacute group (n = 23, 48%). CMR protocol comprised morphology, function, 3D-strain, late gadolinium enhancement (LGE) imaging and mapping (T1, ECV, T2). (4) Results: Highest diagnostic performance in the detection of subacute myocarditis was achieved by ECV evaluation either as single parameter or in combination with T1 mapping (applying a segmental or global increase of native T1 > 1015 ms and ECV > 28%), sensitivity 96% and accuracy 91%. Compared to subacute myocarditis, acute myocarditis demonstrated higher prevalence and extent of LGE (AUC 0.76) and increased T2 (AUC 0.66). (5) Conclusions: A comprehensive CMR approach allows reliable diagnosis of clinically suspected subacute myocarditis. Thereby, ECV alone or in combination with native T1 mapping indicated the best performance for diagnosing subacute myocarditis. Acute vs. subacute myocarditis is difficult to discriminate by CMR alone, due to chronological connection and overlap of pathologic findings.

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Section: Discussionmentioning

confidence: 99%

Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis

Brendel

Klingel

Kübler

et al. 2022

JCM

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“…CMR studies were performed using a 1.5-T magnetic resonance imaging scanner (Gyroscan Intera or Achieva; Philips Healthcare, Best, The Netherlands) with a cardiac-dedicated phased-array coil, under electrocardiogram gating, and breath-holding in line with standard recommendations [ 21 ]. LV volumes were obtained by manual tracing of the epicardial and endocardial contour in end-diastole in the short axis (SA) slices of the continuous SA stack, propagated through all phases using a semi-automated tracing algorithm.…”

Section: Methodsmentioning

confidence: 99%

“…Ten minutes after an intravenous injection of 0.2 mmol/kg gadolinium, inverse recovery sequences were obtained to assess for the presence of gadolinium-enhancing lesions (LGE). The optimal inversion recovery time was defined as previously described [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Diagnosis, management, and outcome of cardiac sarcoidosis and giant cell myocarditis: a Swedish single center experience

Bobbio

Hjalmarsson

Björkenstam

et al. 2022

BMC Cardiovasc Disord

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Background Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) are rare diseases that share some similarities, but also display different clinical and histopathological features. We aimed to compare the demographics, clinical presentation, and outcome of patients diagnosed with CS or GCM. Method We compared the clinical data and outcome of all adult patients with CS (n = 71) or GCM (n = 21) diagnosed at our center between 1991 and 2020. Results The median (interquartile range) follow-up time for patients with CS and GCM was 33.5 [6.5–60.9] and 2.98 [0.6–40.9] months, respectively. In the entire cohort, heart failure (HF) was the most common presenting manifestation (31%), followed by ventricular arrhythmias (25%). At presentation, a left ventricular ejection fraction of < 50% was found in 54% of the CS compared to 86% of the GCM patients (P = 0.014), while corresponding proportions for right ventricular dysfunction were 24% and 52% (P = 0.026), respectively. Advanced HF (NYHA ≥ IIIB) was less common in CS (31%) than in GCM (76%). CS patients displayed significantly lower circulating levels of natriuretic peptides (P < 0.001) and troponins (P = 0.014). Eighteen percent of patients with CS included in the survival analysis reached the composite endpoint of death or heart transplantation (HTx) compared to 68% of patients with GCM (P < 0.001). Conclusion GCM has a more fulminant clinical course than CS with severe biventricular failure, higher levels of circulating biomarkers and an increased need for HTx. The histopathologic diagnosis remained key determinant even after adjustment for markers of cardiac dysfunction.

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“…The fumarate-to-malate hydration reaction is catalyzed by the intracellular enzyme fumarase as part of the tricarboxylic acid cycle. Animal studies have demonstrated that myocyte necrosis exposes the [1,[4][5][6][7][8][9][10][11][12][13] C 2 ] fumarate molecule to fumarase, leading to production of [1,[4][5][6][7][8][9][10][11][12][13] C 2 ]malate, which does not occur when cell membranes are intact. 101 Although yet to be translated to clinical use, hyperpolarized [1,4-13 C 2 ]fumarate holds promise as a biomarker of active necrosis in inflammatory heart diseases and could aid in detecting disease activity and evaluating response to treatment.…”

Section: Carbon ( 13 C) and Hyperpolarized Mrimentioning

confidence: 99%

Imaging Methods: Magnetic Resonance Imaging

Thomas

Fotaki

Botnar

et al. 2023

Circ: Cardiovascular Imaging

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Myocardial inflammation occurs following activation of the cardiac immune system, producing characteristic changes in the myocardial tissue. Cardiovascular magnetic resonance is the non-invasive imaging gold standard for myocardial tissue characterization, and is able to detect image signal changes that may occur resulting from inflammation, including edema, hyperemia, capillary leak, necrosis, and fibrosis. Conventional cardiovascular magnetic resonance for the detection of myocardial inflammation and its sequela include T2-weighted imaging, parametric T1- and T2-mapping, and gadolinium-based contrast-enhanced imaging. Emerging techniques seek to image several parameters simultaneously for myocardial tissue characterization, and to depict subtle immune-mediated changes, such as immune cell activity in the myocardium and cardiac cell metabolism. This review article outlines the underlying principles of current and emerging cardiovascular magnetic resonance methods for imaging myocardial inflammation.

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Cardiovascular Magnetic Resonance in Myocarditis

Cited by 32 publications

References 126 publications

Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis

Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis

Diagnosis, management, and outcome of cardiac sarcoidosis and giant cell myocarditis: a Swedish single center experience

Imaging Methods: Magnetic Resonance Imaging

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