Diagnosis of viral myocarditis by cardiac magnetic resonance and viral genome detection in peripheral blood

Abstract

In patients with acute myocarditis, viral genome can be detected in plasma and peripheral leukocytes. Its relationship with active myocardial inflammation, however, is not well understood. Myocardial edema as a feature of inflammation and myocardial necrosis or fibrosis can be frequently observed in patients with acute myocarditis by cardiovascular magnetic resonance (CMR). We assessed the association of viral genome presence in peripheral blood samples with myocardial edema and irreversible injury. We examined consecutive patients with clinically suspected myocarditis after an episode of viral illness. State-of-the-art methods were used for detecting myocardial edema and irreversible injury using CMR and viral genome applying reverse transcribed, nested polymerase chain reaction in peripheral blood samples. The specificity of viral amplification products was confirmed by automatic DNA sequencing. Of a total of 55 patients (53.5 ± 15.6 years), 21 were positive for viral genome in peripheral leukocytes. Interestingly, 18 (86%) of these patients also showed global myocardial edema, as compared to only 7/34 (21%) without PCR evidence for viral genome. The overall agreement between CMR criteria for edema and viral PCR was 84%. In contrast, there was no significant relationship of viral genome presence with myocardial necrosis or scars. In patients with clinically suspected myocarditis, myocardial edema but not irreversible myocardial injury is associated with the presence of viral genome in peripheral blood.

Viral Nucleic Acids in the Serum Are Dependent on Blood Sampling Site in Patients with Clinical Suspicion of Myocarditis

“…Detection of viral nucleic acids in peripheral leukocytes may indicate recent viral infection, viral reactivation, or persistent infection [29]. The studies performed in patients with viral disease other than MCI have demonstrated that leukocyte samples have the highest sensitivity for viral nucleic acid detection compared to plasma and serum [30].…”

Cardiovascular imaging 2013 in the International Journal of Cardiovascular Imaging

“…The pattern of nulling on the inversion scout sequence was found to be predictive of myocardial amyloid infiltration in a retrospective analysis of 39 patients [56]. The presence of myocardial edema as evidenced by T2-weighted images but not LGE was found to be predictive of the presence of viral genome in the peripheral blood in patients with viral myocarditis [57]. In related work, the elimination of T2 weighted images or early gadolinium enhancement was found to reduce the sensitivity of MRI for diagnosing acute myocarditis [58].…”

Concurrent Exercise-Associated Ventricular Complexes and a Prolonged QT Interval are Associated with Evidence of Myocarditis

“…In addition to 2, 3 and 4-chamber long-axis views, 3-D short-axis volume data was acquired by steadystate free precession imaging to evaluate LV function and dimensions. Phase-contrast velocity images in the ascending aorta were obtained to measure stroke volume and rule out significant aortic insufficiency as described previously [13,15,16]. Functional and morphological data were evaluated using view forum 6.5.…”

“…All patients but no controls underwent ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences (STIR) in a short axis view covering the whole left ventricle as described in our earlier studies [13,15,16]. Late gadolinium enhancement (LGE) imaging was obtained in all patients 10 minutes after iv administration of 0.2 mmol/kg gadolinium-diethylenetriaminepentaacetate using 3D inversion recovery turbo gradient echo sequences as described previously [13,15,16].…”

“…Late gadolinium enhancement (LGE) imaging was obtained in all patients 10 minutes after iv administration of 0.2 mmol/kg gadolinium-diethylenetriaminepentaacetate using 3D inversion recovery turbo gradient echo sequences as described previously [13,15,16].…”