Relation between myocardial edema and myocardial mass during the acute and convalescent phase of myocarditis – a CMR study

Zagrosek, Anja; Waßmuth, Ralf; Abdel-Aty, Hassan; Rudolph, André; Dietz, Rainer; Schulz‐Menger, Jeanette

doi:10.1186/1532-429x-10-19

Cited by 77 publications

(48 citation statements)

References 35 publications

(29 reference statements)

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“…The elevated LVMI in the AMC group (p = 0.034) results from acute inflammation with successive edema. Edema within the myocardium may result in capillary compression and reduced diastolic and systolic cardiac function [20,21]. We were able to identify wall motion abnormalities in 63 % of the AMC group, which can be broken down into regional distribution in 47 % and global distribution in 16 %.…”

Section: Functional Analysismentioning

confidence: 88%

Functional and Morphological Parameters with Tissue Characterization of Cardiovascular Magnetic Imaging in Clinically Verified “Infarct-like Myocarditis”

Schwab¹,

Rogg²,

Pauschinger³

et al. 2015

Fortschr Röntgenstr

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Purpose: Cardiac magnetic resonance (CMR) has increasingly proved to be a valuable diagnostic tool for evaluating patients with suspected myocarditis. The objective of this study was to evaluate the diagnostic value of functional and morphological parameters including tissue characterization in patients with ?infarct-like myocarditis?. Materials and Methods: 43 patients with clinically verified cases of ?infarct-like myocarditis? (median time to MRI scanning after admission for acute symptoms 3 days) and 35 control patients matched by age and sex were included in this retrospective case control study. In this study we used a 1.5?T MRI scanner conducting steady-state-free-precession sequences, T2-weighted imaging, T1-weighted imaging before and after contrast administration and late gadolinium enhancement sequences. According to the recommendations for CMR diagnosis of myocarditis (Lake Louise consensus criteria), a scan was positive for acute myocarditis if 2 of 3 CMR criteria were present. Results: 30?% of the patients with ?infarct-like myocarditis? had a reduced left ventricular ejection fraction, 11?% had an increased LV end-diastolic volume index and 35?% had an increased LV mass index. The sensitivity of wall motion abnormalities was 63?% with a regional distribution in 49?%. In 47?% of cases regional wall motion abnormalities were present in the lateral left ventricular segments. Pericardial effusions were discovered in 65?% of cases with a circular appearance in 21?% and focal manifestation in 44?%. The diagnostic sensitivity, specificity, and accuracy of CMR in patients with ?infarct-like myocarditis? were 67?%, 100?% and 82?%, respectively. The LGE alone was the most sensitive test parameter with 86?%, providing a specificity of 100?% and accuracy of 92?%. Conclusion: Our study results can be applied to the subgroup of patients with ?infarct-like myocarditis?, where we found that LGE alone was the most sensitive test parameter. In addition to tissue characterization, the functional and morphological analysis of patients with acute myocarditis provides a useful further diagnostic tool. Key Points: ??Infarct-like myocarditis can be diagnosed by CMR with high validity and reliability. ??LGE allone performed best with a sensitivity of 86?%. ??Functional and morphological CMR parameters in addition to tissue characterization are useful tool in the diagnosis of acute myocarditis. Citation Format: ??Schwab J, Rogg H-J, Pauschinger M et?al. Functional and Morphological Parameters with Tissue Characterization of Cardiovascular Magnetic Imaging in Clinically Verified ?Infarct-like Myocarditis?. Fortschr R?ntgenstr 2016; 188: 365???373

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Section: Functional Analysismentioning

confidence: 88%

Functional and Morphological Parameters with Tissue Characterization of Cardiovascular Magnetic Imaging in Clinically Verified “Infarct-like Myocarditis”

Schwab¹,

Rogg²,

Pauschinger³

et al. 2015

Fortschr Röntgenstr

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“…127,133,134 Inflammatory myocarditis provokes myocardial edema, and formation of inflammatory infiltrates of lymphocytes and macrophages; both can drive underlying lymphatic pumping disturbances. 135,136 Myocardial edema, in several forms of acute cardiac inflammation, is associated with increased myocardial lymph flow rate and decreased lymphatic outflow resistance. 137 The contractile capacity of collecting lymphatics is often impaired by remote inflammatory diseases, and inflammatory mediators (prostanoids, cytokines and nitric oxide) negatively regulate lymphatic contraction.…”

Section: -125mentioning

confidence: 99%

Anatomy and roles of lymphatics in inflammatory diseases

Al‐Kofahi

Yun

Minagar

et al. 2017

Clinical & Exp Neuroim

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The lymphatic system maintains tissue homeostasis by transporting interstitial fluid, lipids and debris from tissues to the main circulation, and delivers antigen and antigen presenting cells to local lymph nodes where they elicit immune responses. During inflammation, lymph flow increases to limit edema and prevents tissue antigen-presenting cell transport. Lymphatics also adjust their contractile activity to increase fluid transfer during acute inflammation. Conversely, chronic inflammation can provoke lymphostasis, which might limit pathogen spread within the circulation; however, decreased lymph flow leads to the persistence of immune cells and mediators in tissues to intensifying injury. Here, we review lymphatic structure function within the gut, heart and central nervous system, discussing potential roles of these lymphatics in the etiology of inflammatory bowel disease, myocarditis and neurovascular disease, and as novel targets for therapeutic management of several disease states.

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“…Despite scanner-and protocol-dependent variations of image quality, edema-sensitive CMR has shown good diagnostic performance in clinically acute myocarditis. 12,19,20 Edema in the absence of necrosis or scar represents reversible injury and thus can predict functional recovery. 21,22 Figure 5 shows an example of myocardial edema (watersensitive T2-weighted sequence) in a patient with clinically acute myocarditis.…”

Section: Myocardial Edemamentioning

confidence: 99%