Discordance between echocardiographic and MRI findings in two cases of acute myocarditis mimicking myocardial infarction

Kontogianni, Dimitra D.; Kouris, Nikos T.; Papoulia, E.; Goranitou, G.; Grassos, H.; Babalis, Dimitris

doi:10.1016/j.ijcard.2006.07.153

Cited by 13 publications

(5 citation statements)

References 6 publications

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“…ECG abnormalities are usually transient and non-specific, whereas several patients have no electrocardiographic abnormalities [10–12]. In fact, some patients with a normal ECG and negative troponin or creatine kinase test may still have (suspected) myocarditis after or during a viral infection of the respiratory or gastrointestinal tract [13, 14].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of early myocarditis after respiratory or gastrointestinal tract viral infection: insights from cardiovascular magnetic resonance

et al. 2010

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BackgroundThe diagnosis of myocarditis continues to be a challenging task in clinical practice. The purpose of our study was to investigate cardiovascular magnetic resonance imaging in the diagnostic workup of ambulatory patients with the suspicion of early myocarditis after respiratory or gastrointestinal tract viral infection. The need for accurate diagnosis of early myocarditis arises from the low diagnostic accuracy of routine clinical tests.MethodsWe examined 67 consecutive patients with symptoms of weakness, palpitations, and fatigue after respiratory or gastrointestinal tract infection. We compared these patients to 31 controls. ECG-triggered, T2-weighted, fast-spin-echo triple inversion recovery sequences and delayed enhancement imaging were obtained in all patients, as well as functional parameters of left ventricular function and dimensions. In addition, in 25 patients and 10 controls, ECG-triggered, T1-weighted, multi-slice spin-echo images were obtained in axial orientation.ResultsWe found a significant difference between patients with suspected myocarditis and controls in T2-global myocardial signal intensity. In addition, the ratio of global myocardial signal intensity/muscle signal intensity was 2.3 ± 0.4 in patients and 1.8 ± 0.3 in controls, which was highly significant (p < 0.001). In 23 patients, a pathological late enhancement pattern was seen, but only in one of the controls. There was no significant difference in T1-signal parameters.ConclusionCardiovascular magnetic resonance technique is able to detect early myocardial involvement after respiratory or gastrointestinal tract infection.

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Section: Introductionmentioning

confidence: 99%

Diagnosis of early myocarditis after respiratory or gastrointestinal tract viral infection: insights from cardiovascular magnetic resonance

et al. 2010

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“…The myocarditis resolved with steroid therapy. Kontogianni et al [ 81 ] report two male adolescents (15 and 19 years old) who were admitted due to chest pain influenced by the respiratory movements, composing a clinical setting highly indicative of acute myocarditis. The echocardiogram performed in both patients failed to reveal any regional or global wall motion abnormalities or even diastolic dysfunction and remained absolutely normal throughout their 3-month follow-up period.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive imaging in the diagnosis of acute viral myocarditis

et al. 2009

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Autopsy series of consecutive cases have demonstrated an incidence of myocarditis at approximately 1-10%; on the contrary, myocarditis is seriously underdiagnosed clinically. In a traditional view, the gold standard has been myocardial biopsy. However, it is generally specific but invasive and less sensitive, mostly because of the focal nature of the disease. Thus, non-invasive approaches to detect myocarditis are necessary. The traditional diagnostic tools are electrocardiography, laboratory values, especially troponin T or I, creatine kinase and echocardiography. For a long period, nuclear technique with indium-111 antimyosin antibody has been used as a diagnostic approach. In the last years, the use of this technique has declined because of radiation exposure and 48-h delay in obtaining imaging after injection to prevent blood pool effect. Thus, a non-invasive diagnostic approach without radiation and online image availability has been awaited. Cardiac magnetic resonance imaging has these promising characteristics. With this technique, it is possible to analyse inflammation, oedema and necrosis in addition to functional parameters such as left ventricular function, regional wall motion and dimensions. Thus, cardiovascular magnetic resonance imaging has emerged as the most important imaging tool in the diagnostic procedure and the review focus on this field. But there are also advances in echocardiography and computer tomography, which are described in detail.

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We have strongly appreciated a recently published paper by Kontogianni DD et al that validates the important role of magnetic resonance imaging (MRI) to diagnose acute focal myocarditis [1].They have reported two cases of acute focal myocarditis, mimicking acute myocardial infarction, characterized by discordance between the clinical picture, the electrocardiographic abnormalities, the extensive MRI contrast enhancement and the normal left ventricular wall motion on echocardiogram.The paper confirms a recent manuscript of ours published on this journal that showed the possibility to diagnose by MRI the focal myocardial edema located in the subepicardial layer and normal left ventricular wall motion in patients with myocarditis [2].In addition to the intrinsic advantages of MRI with respect to other imaging techniques (i.e. high spatial resolution, no ionising radiation, no iodatined contrast media), MRI shows many important diagnostic information in patients with suspected myocarditis.

The localization of myocardial damage by delayed contrast enhancement MRI permits to obtain a differential diagnosis between myocardial infarction and myocarditis.

During myocardial infarction, myocardial damage always involves the subendocardial layer of ventricular wall [3], on the contrary during acute myocarditis, myocardial damage can be located in any myocardial portions of ventricular wall, even if it is typically located in the subepicardial layer of lateral wall [2].

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mentioning

confidence: 79%

“…We have strongly appreciated a recently published paper by Kontogianni DD et al that validates the important role of magnetic resonance imaging (MRI) to diagnose acute focal myocarditis [1].…”

mentioning

confidence: 84%

Acute myocarditis with normal systolic wall thickening: Inside physiopathological mechanisms and diagnostic imaging techniques

Bella

Carerj

Coglitore

2008

International Journal of Cardiology

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Discordance between echocardiographic and MRI findings in two cases of acute myocarditis mimicking myocardial infarction

Cited by 13 publications

References 6 publications

Diagnosis of early myocarditis after respiratory or gastrointestinal tract viral infection: insights from cardiovascular magnetic resonance

Diagnosis of early myocarditis after respiratory or gastrointestinal tract viral infection: insights from cardiovascular magnetic resonance

Non-invasive imaging in the diagnosis of acute viral myocarditis

Acute myocarditis with normal systolic wall thickening: Inside physiopathological mechanisms and diagnostic imaging techniques

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