Marco Francone1, Cristina Chimenti2, Nicola Galea1, Fernanda Scopelliti3, Romina Verardo3, Roberto Galea4, Iacopo Carbone1, Carlo Catalano1, Francesco Fedele5, Andrea Frustaci6. 1. Department of Radiology, Oncology and Pathology, La Sapienza University, Rome, Italy. 2. Department of Cardiovascular, Respiratory, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy; IRCCS San Raffaele La Pisana, Rome, Italy. 3. IRCCS L. Spallanzani, Rome, Italy. 4. Fondazione IRCSS Ospedale Maggiore Policlinico Università degli Studi di Milano, Rome, Italy. 5. Department of Cardiovascular, Respiratory, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy. 6. Department of Cardiovascular, Respiratory, Nefrologic, Anestesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy; IRCCS L. Spallanzani, Rome, Italy. Electronic address: biocard@inmi.it.
Abstract
OBJECTIVES: The aim of this study was to determine whether clinical presentation and type of cell death in acute myocarditis might contribute to cardiac magnetic resonance (CMR) sensitivity. BACKGROUND: Growing evidence indicates CMR is the reference noninvasive tool for the diagnosis of acute myocarditis. However, factors affecting CMR sensitivity are still unclear. METHODS: We retrospectively evaluated 57 consecutive patients with a diagnosis of acute myocarditis made on the basis of clinical history (≤3 months) and endomyocardial biopsy evidence of lymphocytic infiltrates (≥14 infiltrating leukocytes/mm(2) at immunohistochemistry) in association with damage of the adjacent myocytes and absence or minimal evidence of myocardial fibrosis. CMR acquisition protocol included T2-weighted (edema), early (hyperemia), and late (fibrosis/necrosis) gadolinium enhancement sequences. Presence of ≥2 CMR criteria denoted myocarditis. Type of cell death was evaluated by using in situ ligation with hairpin probes. RESULTS: Three clinical myocarditis patterns were recognized: infarct-like (pattern 1, n = 21), cardiomyopathic (pattern 2, n = 21), and arrhythmic (pattern 3, n = 15). Tissue edema was observed in 81% of pattern 1, 28% of pattern 2, and 27% of pattern 3. Early enhancement was evident in 71% of pattern 1, 67% of pattern 2, and 40% of pattern 3. Late gadolinium enhancement was documented in 71% of pattern 1, 57% of pattern 2, and 47% of pattern 3. CMR sensitivity was significantly higher in pattern 1 (80%) compared with pattern 2 (57%) and pattern 3 (40%) (p < 0.05). Cell necrosis was the prevalent mechanism of death in pattern 1 compared with pattern 2 (p < 0.001) and pattern 3 (p < 0.05), whereas apoptosis prevailed in pattern 2 (p < 0.001 vs. pattern 1 and p < 0.05 vs. pattern 3). CONCLUSIONS: In acute myocarditis, CMR sensitivity is high for infarct-like, low for cardiomyopathic, and very low for arrhythmic clinical presentation; it correlates with the extent of cell necrosis-promoting expansion of interstitial space.
OBJECTIVES: The aim of this study was to determine whether clinical presentation and type of cell death in acute myocarditis might contribute to cardiac magnetic resonance (CMR) sensitivity. BACKGROUND: Growing evidence indicates CMR is the reference noninvasive tool for the diagnosis of acute myocarditis. However, factors affecting CMR sensitivity are still unclear. METHODS: We retrospectively evaluated 57 consecutive patients with a diagnosis of acute myocarditis made on the basis of clinical history (≤3 months) and endomyocardial biopsy evidence of lymphocytic infiltrates (≥14 infiltrating leukocytes/mm(2) at immunohistochemistry) in association with damage of the adjacent myocytes and absence or minimal evidence of myocardial fibrosis. CMR acquisition protocol included T2-weighted (edema), early (hyperemia), and late (fibrosis/necrosis) gadolinium enhancement sequences. Presence of ≥2 CMR criteria denoted myocarditis. Type of cell death was evaluated by using in situ ligation with hairpin probes. RESULTS: Three clinical myocarditis patterns were recognized: infarct-like (pattern 1, n = 21), cardiomyopathic (pattern 2, n = 21), and arrhythmic (pattern 3, n = 15). Tissue edema was observed in 81% of pattern 1, 28% of pattern 2, and 27% of pattern 3. Early enhancement was evident in 71% of pattern 1, 67% of pattern 2, and 40% of pattern 3. Late gadolinium enhancement was documented in 71% of pattern 1, 57% of pattern 2, and 47% of pattern 3. CMR sensitivity was significantly higher in pattern 1 (80%) compared with pattern 2 (57%) and pattern 3 (40%) (p < 0.05). Cell necrosis was the prevalent mechanism of death in pattern 1 compared with pattern 2 (p < 0.001) and pattern 3 (p < 0.05), whereas apoptosis prevailed in pattern 2 (p < 0.001 vs. pattern 1 and p < 0.05 vs. pattern 3). CONCLUSIONS: In acute myocarditis, CMR sensitivity is high for infarct-like, low for cardiomyopathic, and very low for arrhythmic clinical presentation; it correlates with the extent of cell necrosis-promoting expansion of interstitial space.
Authors: Bettina Baeßler; Frank Schaarschmidt; Melanie Treutlein; Christian Stehning; Bernhard Schnackenburg; Guido Michels; David Maintz; Alexander C Bunck Journal: Eur Radiol Date: 2017-06-27 Impact factor: 5.315
Authors: Julius L Katzmann; Peter Schlattmann; Angelos G Rigopoulos; Ewa Noutsias; Boris Bigalke; Matthias Pauschinger; Carsten Tschope; Daniel Sedding; P Christian Schulze; Michel Noutsias Journal: Heart Fail Rev Date: 2020-03 Impact factor: 4.214