LGE-MRI in the Assessment of Left-ventricular Remodelling in Myocarditis

Author(s): Wei-Feng Yuan, Xin-Xiang Zhao*, Wen-Jing Sun, Shao-Ping Wu, Ya-Bin Liu, Xi Tang.

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 15 , Issue 9 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: The exact morbidity of myocarditis is unknown, as the treatment is generally delayed in virtue of misdiagnosis or missed diagnosis.

Aim: The aim of this study was to identify prognostic factors of left-ventricular remodeling on CMRI performed in patients with pathological proven myocarditis.

Methods: Sixty-two cases with various presentations of myocarditis (39 cases with heart failure; 23 cases with arrhythmias) were selected. All patients, who underwent coronary angiography, endomyocardial biopsy, were divided into positive-remodeling and negative-remodelling groups to analyse LGE and cardiac cine parameters at presentation and subsequent to 3 months.

Results: Comparison of two subgroups in CMRI is as follows: positive LGE (65.6% vs. 86.7%; p<0.05), LVEF (41.3±14.8% vs. 37.6±10.1%; p=0.62), (25.7±2.0% vs. 24.0±2.5%; p=0.81), (44.5±3.9mm vs. 46.3±5.4mm; p=0.76), (129.1±8.5ml vs. 135.3±12.2ml; p=0.26), (74.8±7.3ml vs. 79.1±10.0ml; p=0.55), (52.0±5.7g vs. 49.6±6.5g; p=0.71), (34.9±3.5ml vs. 32.4±6.2ml; p=0.68), (3.8±0.7L/min vs. 3.1±0.5L/min; p=0.64), (2.9±0.6L/min*m2 vs. 2.7±0.5L/min*m2; p=0.79).

Conclusion: LGE-MRI is rewarding as an independent predictor in left-ventricular positive and negative remodelling of myocarditis.

Keywords: Myocarditis, remodelling, heart failure, arrhythmias, magnetic resonance imaging, angiography.

[1]
Sagar S, Liu PP, Cooper LT Jr. Myocarditis. Lancet 2012; 379(9817): 738-47.
[http://dx.doi.org/10.1016/S0140-6736(11)60648-X] [PMID: 22185868]
[2]
Cooper LT Jr. Myocarditis. N Engl J Med 2009; 360(15): 1526-38.
[http://dx.doi.org/10.1056/NEJMra0800028] [PMID: 19357408]
[3]
Dec GW Jr, Waldman H, Southern J, Fallon JT, Hutter AM Jr, Palacios I. Viral myocarditis mimicking acute myocardial infarction. J Am Coll Cardiol 1992; 20(1): 85-9.
[http://dx.doi.org/10.1016/0735-1097(92)90141-9] [PMID: 1607543]
[4]
Fabre A, Sheppard MN. Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Heart 2006; 92(3): 316-20.
[http://dx.doi.org/10.1136/hrt.2004.045518] [PMID: 15923280]
[5]
Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation 2006; 113(6): 876-90.
[http://dx.doi.org/10.1161/circulationaha.105.584532] [PMID: 16476862]
[6]
Feldman AM, McNamara D. Myocarditis. N Engl J Med 2000; 343(19): 1388-98.
[http://dx.doi.org/10.1056/NEJM200011093431908] [PMID: 11070105]
[7]
Bowles NE, Ni J, Kearney DL, et al. Detection of viruses in myocardial tissues by polymerase chain reaction. Evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol 2003; 42(3): 466-72.
[http://dx.doi.org/10.1016/S0735-1097(03)00648-X] [PMID: 12906974]
[8]
Laraudogoitia Zaldumbide E, Pérez-David E, Larena JA, et al. The value of cardiac magnetic resonance in patients with acute coronary syndrome and normal coronary arteries. Rev Esp Cardiol 2009; 62(9): 976-83.
[PMID: 19712618]
[9]
Cummings KW, Bhalla S, Javidan-Nejad C, Bierhals AJ, Gutierrez FR, Woodard PK. A pattern-based approach to assessment of delayed enhancement in nonischemic cardiomyopathy at MR imaging. Radiographics 2009; 29(1): 89-103.
[http://dx.doi.org/10.1148/rg.291085052] [PMID: 19168838]
[10]
Mouquet F, Lions C, de Groote P, et al. Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging. Eur Radiol 2008; 18(12): 2765-9.
[http://dx.doi.org/10.1007/s00330-008-1067-x] [PMID: 18642002]
[11]
Srichai MB, Junor C, Rodriguez LL, et al. Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J 2006; 152(1): 75-84.
[http://dx.doi.org/10.1016/j.ahj.2005.08.021] [PMID: 16824834]
[12]
Cerqueira MD, Weissman NJ, Dilsizian V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac imaging committee of the council on clinical cardiology of the american heart association. J Am Soc Echocardiogr 2002; 15(5): 463-7.
[http://dx.doi.org/10.1067/mje.2002.123374]
[13]
Friedrich MG, Sechtem U, Schulz-Menger J, et al. International consensus group on cardiovascular magnetic resonance in myocarditis. cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 2009; 53(17): 1475-87.
[http://dx.doi.org/10.1016/j.jacc.2009.02.007] [PMID: 19389557]
[14]
Bax JJ, Abraham T, Barold SS, et al. Cardiac resynchronization therapy: Part 2-issues during and after device implantation and unresolved questions. J Am Coll Cardiol 2005; 46(12): 2168-82.
[http://dx.doi.org/10.1016/j.jacc.2005.09.020] [PMID: 16360043]
[15]
Sandstede JJW, Lipke C, Beer M, et al. Analysis of first-pass and delayed contrast-enhancement patterns of dysfunctional myocardium on MR imaging: Use in the prediction of myocardial viability. AJR Am J Roentgenol 2000; 174(6): 1737-40.
[http://dx.doi.org/10.2214/ajr.174.6.1741737] [PMID: 10845515]
[16]
Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation 2006; 113(4): 593-5.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.589663] [PMID: 16449736]
[17]
Yoshikawa T, Baba A, Nagatomo Y. Autoimmune mechanisms underlying dilated cardiomyopathy. Circ J 2009; 73(4): 602-7.
[http://dx.doi.org/10.1253/circj.CJ-08-1151] [PMID: 19246813]
[18]
Kühl U, Pauschinger M, Schwimmbeck PL, et al. Interferon-β treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation 2003; 107(22): 2793-8.
[http://dx.doi.org/10.1161/01.CIR.0000072766.67150.51] [PMID: 12771005]
[19]
Dornier C, Somsen GA, Ivancevic MK, et al. Comparison between tagged MRI and standard cine MRI for evaluation of left ventricular ejection fraction. Eur Radiol 2004; 14(8): 1348-52.
[http://dx.doi.org/10.1007/s00330-004-2311-7] [PMID: 15067425]
[20]
Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling-concepts and clinical implications: A consensus paper from an international forum on cardiac remodelling. J Am Coll Cardiol 2000; 35(3): 569-82.
[http://dx.doi.org/10.1016/S0735-1097(99)00630-0] [PMID: 10716457]
[21]
Pfeffer MA, Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation 1990; 81(4): 1161-72.
[http://dx.doi.org/10.1161/01.CIR.81.4.1161] [PMID: 2138525]
[22]
St John Sutton M, Pfeffer MA, Moye L, et al. Cardiovascular death and left ventricular remodeling two years after myocardial infarction: Baseline predictors and impact of long-term use of captopril: information from the Survival and Ventricular Enlargement (SAVE) trial. Circulation 1997; 96(10): 3294-9.
[http://dx.doi.org/10.1161/01.CIR.96.10.3294] [PMID: 9396419]
[23]
Gaudron P, Eilles C, Kugler I, Ertl G. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation 1993; 87(3): 755-63.
[http://dx.doi.org/10.1161/01.CIR.87.3.755] [PMID: 8443896]
[24]
Miller S, Simonetti OP, Carr J, Kramer U, Finn JP. MR Imaging of the heart with cine true fast imaging with steady-state precession: Influence of spatial and temporal resolutions on left ventricular functional parameters. Radiology 2002; 223(1): 263-9.
[http://dx.doi.org/10.1148/radiol.2231010235] [PMID: 11930076]
[25]
Kim RJ. Assessment of myocardial viability by contrast enhancement. In: Higgins CB, Roos A, Eds. MRI and CT of the cardiovascular system. 2nd ed. Philadelphia: Lippincott Willams & Wilkins 2006; pp. 233-62.
[26]
Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J 2005; 26(15): 1461-74.
[http://dx.doi.org/10.1093/eurheartj/ehi258] [PMID: 15831557]
[27]
Kitagawa K, Sakuma H, Hirano T, Okamoto S, Makino K, Takeda K. Acute myocardial infarction: myocardial viability assessment in patients early thereafter comparison of contrast-enhanced MR imaging with resting (201)Tl SPECT. Single photon emission computed tomography. Radiology 2003; 226(1): 138-44.
[http://dx.doi.org/10.1148/radiol.2261012108] [PMID: 12511682]
[28]
Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: A comparison to histology and molecular pathology. Circulation 2004; 109(10): 1250-8.
[http://dx.doi.org/10.1161/01.CIR.0000118493.13323.81] [PMID: 14993139]
[29]
Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 2006; 114(15): 1581-90.
[http://dx.doi.org/10.1161/circulationaha.105.606509] [PMID: 17015795]
[30]
Blom AS, Mukherjee R, Pilla JJ, et al. Cardiac support device modifies left ventricular geometry and myocardial structure after myocardial infarction. Circulation 2005; 112(9): 1274-83.
[http://dx.doi.org/10.1161/circulationaha.104.499202] [PMID: 16129812]
[31]
Orn S, Manhenke C, Anand IS, et al. Effect of left ventricular scar size, location, and transmurality on left ventricular remodeling with healed myocardial infarction. Am J Cardiol 2007; 99(8): 1109-14.
[http://dx.doi.org/10.1016/j.amjcard.2006.11.059] [PMID: 17437737]
[32]
Azevedo CF, Nigri M, Higuchi ML, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol 2010; 56(4): 278-87.
[http://dx.doi.org/10.1016/j.jacc.2009.12.074] [PMID: 20633819]
[33]
Choudhury L, Mahrholdt H, Wagner A, et al. Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40(12): 2156-64.
[http://dx.doi.org/10.1016/S0735-1097(02)02602-5] [PMID: 12505229]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 9
Year: 2019
Page: [900 - 905]
Pages: 6
DOI: 10.2174/1573405614666180912100253

Article Metrics

PDF: 16