Phenotyping of giant cell myocarditis versus cardiac sarcoidosis using cardiovascular magnetic resonance

Bobbio, Emanuele; Bollano, Entela; Oldfors, Anders; Hedner, H; Björkenstam, Marie; Svedlund, Sara; Karason, Kristjan; Bergh, Niklas; Polte, Christian L.

doi:10.1016/j.ijcard.2023.131143

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…There is limited data on the use of CMR in patients with IGCM, owing to the rarity and high mortality associated with the disorder. CMR appearance of IGCM and cardiac sarcoidosis is highly similar, including evidence of multifocal late gadolinium enhancement and the presence of the “hook sign” (prominent involvement of the anteroseptal and inferoseptal insertion points of the right ventricle, with direct and contiguous extension across the septum into the right ventricle), which makes differentiating between the 2 rare entities solely based on CMR challenging [ 16 , 17 ]. Furthermore, CMR cannot differentiate IGCM from cardiac sarcoidosis, which has similar clinical manifestations to IGCM, such as heart failure, heart block, and ventricular tachyarrhythmias [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Unraveling the Uncommon: A Case Report of Giant Cell Myocarditis and Examination of Existing Literature

Gonzalez Moret,

Jarrett,

Ahktar

et al. 2024

Am J Case Rep

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Patient: Female, 65-year-old Final Diagnosis: Giant cell myocarditis Symptoms: Palpitation • shortness of breath Clinical Procedure: — Specialty: Cardiology Objective: Unusual clinical course Background: Idiopathic giant cell myocarditis (IGCM) is an uncommon and frequently fatal type of myocarditis. It primarily affects young individuals and has the potential to result in heart failure and life-threatening arrhythmias. IGCM seems to be dependent on activation of CD4-positive T lymphocytes and can show improvement with treatment aimed at reducing T-cell function. We present a case of a 65-year-old patient who presented with features of acute heart failure refractory to guideline-directed medical therapy (GDMT), due to IGCM. A review of the natural history and treatment of IGCM is also presented. Case Report: A 65-year-old woman with multiple comorbidities was admitted to our hospital for ventricular tachycardia in the setting of progressive non-ischemic heart failure, unresponsive to GDMT. This led to further investigation, including an endomyocardial biopsy, which revealed inflammatory infiltration, with multinucleated giant cells and lymphocytes in the absence of granuloma formation, prompting a diagnosis of IGCM. An implantable cardioverter-defibrillator (ICD) was placed for secondary prevention of sudden cardiac death and the patient was initiated on combined immunosuppressive therapy. Owing to numerous comorbidities, she was determined to be unsuitable for a heart transplant. Unfortunately, she eventually died from complications secondary to the disease. Conclusions: IGCM remains a challenging clinical diagnosis with a poor long-term outcome without heart transplantation. This case highlights the importance of considering atypical causes of heart failure in patients who do not respond to conventional therapies. Early recognition and appropriate management, involving medical and interventional approaches, are crucial in improving outcomes for patients with IGCM.

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Section: Discussionmentioning

confidence: 99%

Unraveling the Uncommon: A Case Report of Giant Cell Myocarditis and Examination of Existing Literature

Gonzalez Moret,

Jarrett,

Ahktar

et al. 2024

Am J Case Rep

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“…In some cases, an echocardiogram can be unremarkable [82,87]. The CMRI appearance of GCM is highly similar to CS, showing varying LGE that can involve all myocardial layers as well as both ventricles, including the right ventricular insertion points [91,92]. This makes the differentiation between both entities solely based on CMRI extremely challenging, which underlines the important role of EMB in these cases, as it is the only method that can definitively confirm the diagnosis.…”

Section: Imaging Biomarkersmentioning

confidence: 99%

Biomarkers in Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Updated Review of the Literature

Crisci,

Bobbio,

Gentile

et al. 2023

JCM

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Myocarditis is a disease caused by cardiac inflammation that can progress to dilated cardiomyopathy, heart failure, and eventually death. Several etiologies, including autoimmune, drug-induced, and infectious, lead to inflammation, which causes damage to the myocardium, followed by remodeling and fibrosis. Although there has been an increasing understanding of pathophysiology, early and accurate diagnosis, and effective treatment remain challenging due to the high heterogeneity. As a result, many patients have poor prognosis, with those surviving at risk of long-term sequelae. Current diagnostic methods, including imaging and endomyocardial biopsy, are, at times, expensive, invasive, and not always performed early enough to affect disease progression. Therefore, the identification of accurate, cost-effective, and prognostically informative biomarkers is critical for screening and treatment. The review then focuses on the biomarkers currently associated with these conditions, which have been extensively studied via blood tests and imaging techniques. The information within this review was retrieved through extensive literature research conducted on major publicly accessible databases and has been collated and revised by an international panel of experts. The biomarkers discussed in the article have shown great promise in clinical research studies and provide clinicians with essential tools for early diagnosis and improved outcomes.

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Insights of Inflammatory Heart Involvement in Cardiac Sarcoidosis – A Systemic Review

Treiber,

Hamm,

Sossalla

et al. 2024

Curr Cardiovasc Imaging Rep

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Purpose of the Review The purpose of this paper is to review the current knowledge regarding imaging inflammation in cardiac sarcoidosis (CS). Recent Findings Noninvasive imaging methods like cardiac magnetic resonance (CMR) and 18-fluorodeoxyglucose (18FDG) positron-emission tomography-computed tomography (PET-CT) scans have emerged as the most important modalities in diagnosing and monitor therapy efficacy in CS. The differentiation between an active and a chronic, silent clinical state is crucial for decision making. T1- and T2-mapping by CMR provide a unique opportunity to discriminate normal and diseased myocardium by detecting myocardial edema and fibrosis. While T1-mapping is sensitive to fibrosis and edema, T2 is primarily influenced by tissue water content. Increased 18-fluorodeoxyglucose (18FDG) uptake in positron-emission tomography-computed tomography (PET-CT) scan is a hallmark feature of CS and defines active inflammation. Therefore, the hybrid application of both CMR and 18FDG-PET-CT scans has evolved as the standard procedure to detect CS and monitor the therapeutic response. Summary Imaging inflammation in CS is basically performed by CMR T2-mapping and 18FDG uptake in PET-CT scan. Both are reliable methods in identifying active CS and follow up therapy and can be used synergistically. Additionally CMR provides further prognostic insights by late gadolinium enhancement that increases the risk for malignant arrhythmia and for relapse after therapy weaning.

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Phenotyping of giant cell myocarditis versus cardiac sarcoidosis using cardiovascular magnetic resonance

Cited by 6 publications

References 32 publications

Unraveling the Uncommon: A Case Report of Giant Cell Myocarditis and Examination of Existing Literature

Unraveling the Uncommon: A Case Report of Giant Cell Myocarditis and Examination of Existing Literature

Biomarkers in Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Updated Review of the Literature

Insights of Inflammatory Heart Involvement in Cardiac Sarcoidosis – A Systemic Review

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