Cardiac Magnetic Resonance Assessment of Myocarditis

Friedrich, Matthias G.; Marcotte, François

doi:10.1161/circimaging.113.000416

Cited by 155 publications

(122 citation statements)

References 33 publications

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“…Noninvasive investigations in our patient showed no evidence of myocardial injury. In particular, CMR is a highly sensitive technique for detecting myocardial edema with T2 imaging and myocardial necrosis by late gadolinium enhancement imaging, neither of which were present (12 ). The coexistence of a very low concentration of hs-cTnI and the brisk biochemical response to treatment all helped to rule-out myocardial injury and it is much more likely that the increased hs-cTnT concentrations originated as a consequence of the skeletal myopathy.…”

Section: Discussionmentioning

confidence: 99%

A 61-Year-Old Woman with Muscle Fatigue and Increased Cardiac Troponin

et al. 2017

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A 61-year-old woman presented with a 12-month history of progressive muscle weakness, especially involving the proximal limb muscles. Her symptoms were associated with muscular fatigue such that she was compelled to sit and rest after walking only 30 -50 m. She reported difficulty climbing stairs and standing from a sitting position. There was no rash or Raynaud phenomenon but she did report some episodes of feeling hot and perspiring. She denied any paresthesia, headache, or chest pain. Her past history included sigmoid diverticular disease, osteoarthritis of the cervical spine, and depression for over 20 years with psychotic features in the last 2-3 years. Her medications were aripiprazole 5 mg daily, irbesartan 150 mg daily, amisulpride 150 mg daily, imipramine 50 mg nocte, lercanidipine 10 mg daily, and sertraline 300 mg daily. She had also recently started replacement therapies for B12 and vitamin D deficiencies. Salient examination findings included a general reduction in muscle power, proximal greater than distal, with intact reflexes and sensation.Initial investigation included an erythrocyte sedimentation rate of 32 mm/h [reference interval (RI) Ͻ20], creatine kinase (CK) 4 activity of 1900 U/L (RI Ͻ140), negative screen for antinuclear and extractable nuclear antigen antibodies, and a negative myositis autoantibody panel. The patient was biochemically euthyroid [thyroid stimulating hormone 1.95 mU/L (RI 0.1-5.0)] and had no evidence of renal dysfunction, with creatinine of 0.75 mg/dL [66 mol/L; RI 0.51-1.02 mg/dL (45-90 mol/L)]. MRI of the right thigh did not show features of myositis. The patient was admitted to the hospital for a trial withdrawal of her antipsychotic medication but after 5 days there was no change in her condition. CK remained increased at 510 U/L with a CK-MB fraction of 11.8% (RI Ͻ4%). Cardiac troponin T (cTnT) was 83 ng/L (99th percentile Ͻ14) measured using the highsensitivity cTnT (hs-cTnT) assay (Roche Diagnostics). The electrocardiogram showed normal sinus rhythm and was otherwise unremarkable. Transthoracic echocardiography showed normal left ventricular size and systolic function without segmental abnormalities. Right ventricular function was normal. There were minor, nonspecific degenerative valve abnormalities only. Estimated pulmonary artery pressures were mildly increased but there was no pericardial effusion.Measurement of cardiac troponin I (cTnI) was 2 ng/L (99th percentile in females Ͻ16) with a highsensitivity cTnI (hs-cTnI) assay (Abbott Diagnostics). The following day paired samples revealed hs-cTnT as 82 ng/L, and hs-cTnI as 4 ng/L. Testing for cTnT was repeated with the hs-cTnT assay after treatment with heterophile antibody blocking agents and remained increased.Cardiac MRI (CMR) using steady-state-free precession cine imaging, T2 imaging, and late gadolinium enhancement according to the Lake Louise Criteria for CMR in Myocarditis (1 ) showed normal left ventricular mass, dimensions, and function. There was no CMR evidence of myocarditis or myocardial edema, no...

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Section: Discussionmentioning

confidence: 99%

A 61-Year-Old Woman with Muscle Fatigue and Increased Cardiac Troponin

et al. 2017

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“…The present report highlights the role of CMR imaging to identify acute myocarditis as the underlying cause. The epicardial distribution of edema and necrosis is a hallmark of myocarditis, as opposed to ischemic injury caused by epicardial coronary artery disease which necessarily leads to injury including the subendocardium [3][4][5][6] . Myocarditis and epicardial coronary artery disease imply differences in medical treatment, therefore CMR enables the non-invasive assessment of changes in myocardial tissue composition (myocardial edema, hyperemia, and necrosis) and thus allowed for establishing the diagnosis of acute myocarditis [3][4][5][6] .…”

Section: Discussionmentioning

confidence: 99%

Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

Kumar

Bagur

Béliveau

et al. 2014

WJC

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A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause. Key words: Myocarditis; Acute coronary syndrome; Coronary spasm; Myocardial infarction Core tip: The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause of coronary spasm presenting with ST-segment elevation myocardial infarction in a young healthy man.Kumar A, Bagur R, Béliveau P, Potvin JM, Levesque P, Fillion N, Tremblay B, Larose É, Gaudreault V. Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction.

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“…16 In clinical practice, this technique has impact on the therapeutic decision to indicate corticosteroid therapy or to perform endomyocardial biopsy. 17 …”

Section: Myocarditismentioning

confidence: 99%

New Developments in Magnetic Resonance Imaging of Myocardial Diseases – Technical Aspects and Clinical Applications

Morariu¹,

Bordi²,

Opincariu³

et al. 2017

Journal of Interdisciplinary Medicine

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Cardiac magnetic resonance imaging is an evolving imaging method that can be used in cardiovascular pathology evaluation. Technological developments have increased the clinical utility of cardiac magnetic resonance in the exploration of various cardiac abnormalities. The most important imaging techniques and their utility will be presented in this review, together with the advantages and limitations of cardiac magnetic resonance and with a brief presentation of common cardiac disorders that can be assessed by cardiac magnetic resonance including ischemic heart disease, cardiomyopathies and myocarditis.

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Cardiac Magnetic Resonance Assessment of Myocarditis

Abstract: The online-only Data Supplement is available at http://circimaging.ahajournals.org/lookup/suppl

Cited by 155 publications

References 33 publications

A 61-Year-Old Woman with Muscle Fatigue and Increased Cardiac Troponin

A 61-Year-Old Woman with Muscle Fatigue and Increased Cardiac Troponin

Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

New Developments in Magnetic Resonance Imaging of Myocardial Diseases – Technical Aspects and Clinical Applications

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