Dimitri Patriki1, Eva Gresser1, Robert Manka1, Maximilian Y Emmert2, Thomas F Lüscher3, Bettina Heidecker4. 1. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. 2. Clinic for Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland. 3. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland; Royal Brompton and Harefield Hospital Imperial College London, London, United Kingdom. 4. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. Electronic address: Bettina.Heidecker@usz.ch.
Abstract
OBJECTIVES: This study sought to obtain an approximation of the true incidence of myocarditis by systematic screening of patients at risk using cardiac magnetic resonance imaging (CMR) in a tertiary care center. BACKGROUND: Underdiagnosis of myocarditis and resulting uncertainty about its incidence remain a clinical dilemma. The authors hypothesized that systematic screening of patients presenting with angina-like symptoms, elevated troponin T, and no significant coronary artery disease using CMR will provide an approximation of the true incidence of myocarditis. METHODS: The authors performed a retrospective chart review of patients presenting with angina-like symptoms and elevated high-sensitivity troponin T (TnT-hs ≥14 ng/l) in 2015 and 2016. During the year 2015, only patients with elevated TnT-hs, no significant coronary artery disease, and moderate-to-high clinical likelihood of myocarditis underwent CMR. Starting in 2016, CMR was obtained in patients with similar presentation, but independent of clinical likelihood of myocarditis. RESULTS: A total of 1,788 patients (74% male, age 69 ± 14 years) qualified for our analysis. In 2015, 521 patients presented with angina-like symptoms and TnT-hs elevation. In 2016, the number increased to 1,267 patients. Although in the year 2015, a total of 4 of 88 (5%) CMRs were positive for myocarditis, the percentage of positive CMRs doubled (26 of 199; 13%; p = 0.03) in 2016. CONCLUSIONS: A novel diagnostic screening algorithm led to a 6.3-fold increase of the incidence of myocarditis in our hospital. Furthermore, the percentage of CMRs positive for myocarditis doubled, supporting the diagnostic value of this method. Considering the potentially lethal adverse events of myocarditis if left untreated, we recommend a low threshold for the use of CMR in patients with angina-like symptoms and elevated TnT-hs after exclusion of coronary artery disease.
OBJECTIVES: This study sought to obtain an approximation of the true incidence of myocarditis by systematic screening of patients at risk using cardiac magnetic resonance imaging (CMR) in a tertiary care center. BACKGROUND: Underdiagnosis of myocarditis and resulting uncertainty about its incidence remain a clinical dilemma. The authors hypothesized that systematic screening of patients presenting with angina-like symptoms, elevated troponin T, and no significant coronary artery disease using CMR will provide an approximation of the true incidence of myocarditis. METHODS: The authors performed a retrospective chart review of patients presenting with angina-like symptoms and elevated high-sensitivity troponin T (TnT-hs ≥14 ng/l) in 2015 and 2016. During the year 2015, only patients with elevated TnT-hs, no significant coronary artery disease, and moderate-to-high clinical likelihood of myocarditis underwent CMR. Starting in 2016, CMR was obtained in patients with similar presentation, but independent of clinical likelihood of myocarditis. RESULTS: A total of 1,788 patients (74% male, age 69 ± 14 years) qualified for our analysis. In 2015, 521 patients presented with angina-like symptoms and TnT-hs elevation. In 2016, the number increased to 1,267 patients. Although in the year 2015, a total of 4 of 88 (5%) CMRs were positive for myocarditis, the percentage of positive CMRs doubled (26 of 199; 13%; p = 0.03) in 2016. CONCLUSIONS: A novel diagnostic screening algorithm led to a 6.3-fold increase of the incidence of myocarditis in our hospital. Furthermore, the percentage of CMRs positive for myocarditis doubled, supporting the diagnostic value of this method. Considering the potentially lethal adverse events of myocarditis if left untreated, we recommend a low threshold for the use of CMR in patients with angina-like symptoms and elevated TnT-hs after exclusion of coronary artery disease.
Authors: Tommaso Di Noto; Jochen von Spiczak; Manoj Mannil; Elena Gantert; Paolo Soda; Robert Manka; Hatem Alkadhi Journal: Radiol Cardiothorac Imaging Date: 2019-12-19
Authors: Jan Berg; Marina Lovrinovic; Nora Baltensperger; Christine K Kissel; Jan Kottwitz; Robert Manka; Dimitri Patriki; Frank Scherff; Christian Schmied; Ulf Landmesser; Thomas F Lüscher; Bettina Heidecker Journal: Open Heart Date: 2019-04-23
Authors: Rafael Blanco-Domínguez; Raquel Sánchez-Díaz; Hortensia de la Fuente; Luis J Jiménez-Borreguero; Adela Matesanz-Marín; Marta Relaño; Rosa Jiménez-Alejandre; Beatriz Linillos-Pradillo; Katerina Tsilingiri; María L Martín-Mariscal; Laura Alonso-Herranz; Guillermo Moreno; Roberto Martín-Asenjo; Marcos M García-Guimaraes; Katelyn A Bruno; Esteban Dauden; Isidoro González-Álvaro; Luisa M Villar-Guimerans; Amaia Martínez-León; Ane M Salvador-Garicano; Sam A Michelhaugh; Nasrien E Ibrahim; James L Januzzi; Jan Kottwitz; Sabino Iliceto; Mario Plebani; Cristina Basso; Anna Baritussio; Mara Seguso; Renzo Marcolongo; Mercedes Ricote; DeLisa Fairweather; Héctor Bueno; Leticia Fernández-Friera; Fernando Alfonso; Alida L P Caforio; Domingo A Pascual-Figal; Bettina Heidecker; Thomas F Lüscher; Saumya Das; Valentín Fuster; Borja Ibáñez; Francisco Sánchez-Madrid; Pilar Martín Journal: N Engl J Med Date: 2021-05-27 Impact factor: 176.079
Authors: Carsten Tschöpe; Enrico Ammirati; Biykem Bozkurt; Alida L P Caforio; Leslie T Cooper; Stephan B Felix; Joshua M Hare; Bettina Heidecker; Stephane Heymans; Norbert Hübner; Sebastian Kelle; Karin Klingel; Henrike Maatz; Abdul S Parwani; Frank Spillmann; Randall C Starling; Hiroyuki Tsutsui; Petar Seferovic; Sophie Van Linthout Journal: Nat Rev Cardiol Date: 2020-10-12 Impact factor: 49.421