Document Detail


Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias.
MedLine Citation:
PMID:  16631005     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We evaluated the effectiveness of contrast-enhanced cardiac magnetic resonance (CE-CMR) in detecting chronic myocarditis (CM). BACKGROUND: Chronic myocarditis represents a common evolution of acute myocarditis. Although CE-CMR has been revealed to be effective in identifying areas of myocardial damage in acute myocarditis, its role in the diagnosis of chronic myocardial inflammation has not yet been investigated. METHODS: Twenty-three patients with CM underwent CE-CMR and endomyocardial biopsy (EMB). Chronic myocarditis was defined by the presence of: 1) chronic (>6 months) heart failure symptoms and/or repetitive ventricular arrhythmias; 2) no history of recent flu-like symptoms or infections; and 3) histologic evidence of active myocarditis (AM) or borderline myocarditis (BM) according to Dallas criteria. Contrast-enhanced cardiac magnetic resonance included black-blood T2-weighted (BBT2w) images without and with fat saturation and delayed three-dimensional T1 turbo field-echo inversion-recovery sequences obtained 15 min after gadolinium injection. RESULTS: Histology showed AM in 14 patients and BM in 9 patients. FatSat BBT2w revealed the presence of edema in five (36%) patients with AM but not in BM patients. Areas of late enhancement (LE) were observed in 12 (84%) subjects with AM and in 4 (44%) cases with BM. A mid-wall LE pattern was the most frequent finding in both groups while a subepicardial distribution of LE was observed only in patients with AM. CONCLUSIONS: Contrast-enhanced cardiac magnetic resonance identified areas of myocardial inflammation in up to 70% of patients with biopsy-proven CM. We suggest that CE-CMR may be a useful non-invasive diagnostic tool in patients with CM, and it may indicate and even guide the execution of left ventricular EMB with relevant prognostic and therapeutic implications.
Authors:
Francesco De Cobelli; Maurizio Pieroni; Antonio Esposito; Cristina Chimenti; Elena Belloni; Renata Mellone; Tamara Canu; Gianluca Perseghin; Carlo Gaudio; Attilio Maseri; Andrea Frustaci; Alessandro Del Maschio
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2006-03-29
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  47     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-24     Completed Date:  2006-05-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1649-54     Citation Subset:  AIM; IM    
Affiliation:
Radiology Department, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan, Italy. francesco.decobelli@hsr.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arrhythmias, Cardiac / etiology*
Cardiac Output, Low / etiology*
Chronic Disease
Drug Administration Schedule
Female
Gadolinium / administration & dosage,  diagnostic use*
Genome, Viral
Heart Catheterization
Humans
Image Enhancement*
Magnetic Resonance Angiography
Male
Middle Aged
Myocarditis / complications*,  diagnosis*,  pathology,  virology
Myocardium / pathology
Recurrence
Severity of Illness Index
Chemical
Reg. No./Substance:
7440-54-2/Gadolinium

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