Diagnostic accuracy of antimyosin scintigraphy in suspected myocarditis

Narula, Jagat; Khaw, Ban An; Dec, GW; Palacios, Igor F.; Newell, John; Southern, James F.; Fallon, John T.; Strausś, H. William; Haber, Edgar; Yasuda, Tsunehiro

doi:10.1016/s1071-3581(96)90070-7

Cited by 54 publications

(26 citation statements)

References 31 publications

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“…In subjects with symptom duration of Ͻ4 weeks, up to 89% may have lymphocytic myocarditis, 50 but generally the yield is lower, between 10% and 35% depending on the "gold standard" used. 1,51 In contrast, the sensitivity of EMB for GCM is 80% to 85% in subjects who subsequently die or undergo heart transplantation. 52 In the setting of anticipated mechanical circulatory device support, a pathological diagnosis of GCM may lead to use of a biventricular device because of the likelihood of progressive right ventricular failure.…”

Section: Clinical Scenariomentioning

confidence: 99%

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

Cooper¹,

Baughman²,

Feldman³

et al. 2007

Circulation

761

248

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Section: Clinical Scenariomentioning

confidence: 99%

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

Cooper¹,

Baughman²,

Feldman³

et al. 2007

Circulation

761

248

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“…Among these, antimyosin scintigraphy and Gallium-67 imaging have shown promise in detecting myocyte injury. However, these methods have low specifity and low positive predictive values [5]. Echocardiography has a limited role in the diagnosis of myocarditis, but it can help to identify with fulminant myocarditis at presentation.…”

Section: Introductionmentioning

confidence: 99%

Value of MRI in patients with a clinical suspicion of acute myocarditis

et al. 2007

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The diagnosis of myocarditis is difficult and is generally one of exclusion. Moreover, endomyocardial biopsy (EMB) is not a sensitive technique. Magnetic resonance imaging (MRI), however, has shown promising results in diagnosing myocarditis. We evaluated 20 patients with a clinical suspicion of acute myocarditis. Troponin I levels were elevated in 17/20 patients. Cardiac catheterization (n=13) showed no evidence of coronary artery disease, while normal findings were reported in all five patients who underwent EMB. MRI performed 9.8±7.5 days after the onset of symptoms showed an LV-EDV of 172±50 ml and LV-EF of 57±10%. Abnormalities on delayed contrast-enhanced MRI were found in 15/20 patients, involving 3.7±2.1 segments using the 17-segment model. The lateral LV wall was most frequently involved (61% of enhanced segments). The enhancement was most frequently subepicardial, less often transmural, or midwall (respectively, 67%, 22%, and 11% of enhanced segments). Mild to moderate systolic wall motion abnormalities were invariably found in the abnormally enhancing myocardium on MRI. Associated pericardial effusion was found in six, pericardial enhancement in nine patients. In conclusion, the present study suggests an important role for MRI in evaluating patients with clinical suspicion of acute myocarditis. Not only can the myocardial damage be precisely depicted but also concomitant involvement of the pericardium and impact on regional and global ventricular function can be assessed.

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“…There is still the reduction in the serum concentrations of inflammatory markers, such as IL-6 and TNF-α, which are produced by some cell types, such as macrophages and T lymphocytes CD4. Lower degrees of activation, differentiation, and clonal expansion of lymphocytic populations, both B and T, are seen 4 .…”

Section: Discussionmentioning

confidence: 99%

“…The most accurate noninvasive diagnostic method is indium-111 antimyosin myocardial scintigraphy 4 . This technique is not available in our country.…”

Section: The Patient Is a 60-year-old Female With Functional Class IImentioning

confidence: 99%

Insuficiência renal aguda após uso de imunoglobulina intravenosa para tratamento de miocardite

Pordeus¹,

Tostes²,

Mesquita³

et al. 2005

Arq. Bras. Cardiol.

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The patient is a 60-year-old female with functional class III/ IV (NYHA) heart failure of an immunomediated etiology (autoimmune myocarditis). After unsuccessful therapeutic attempts, intravenous immunoglobulin was used, leading to deterioration in renal function, a rare complication of that therapy. After hemodialysis, the patient's renal function was restored, and the chronic heart failure improved to functional class I.Myocardites constitute a group of diseases characterized by immuno-inflammatory aggression against the myocardium. The anatomicopathological substrate of this aggression has been classically described as a cellular infiltration of lymphocytes, macrophages, and other leukocytes, with destruction of cardiomyocytes, myocytolysis (Dallas criteria) 1 . In past years, advances in understanding of the complex pathophysiology of the disease and low sensitivity of the histopathological criteria have forced us to widen the model of aggression to beyond the immune response of the classical cellular type (Th1). Currently, we believe that an immunomediated aggression against the myocardium occurs, even when the infiltration of immunologic cells is absent. The characterization of pathogenic autoantibodies specific for more than a dozen autoantigens has led us to a new model 2 . The etiology of those diseases is still obscure. Activation of the immunologic system is known to occur, resulting in different forms of myocardial injury. The pathogenic stimuli that lead to the development of that cardiospecific aggression are yet to be elucidated.The current major hypothesis is based on the model of viral infection as the promoter of the immune reaction directed against the heart. Different types of viruses, such as coxsackievirus, parvovirus, adenovirus, cytomegalovirus, Epstein-Barr virus, and parvovirus B19, have often been implicated. However, most clinical studies have shown great variability and low positivity in evidencing the viruses 1 . Other clinical phenomena, such as skin diseases (eg, psoriasis and vitiligo), systemic autoimmune diseases, and even intestinal diseases, such as celiac disease, have been significantly associated with myocardites, suggesting, therefore, a wide and complex pathophysiological model 3 .The clinical findings of myocardites are highly varied. Their symptoms may range from fever and malaise to cardiac symptoms, such as palpitation, dyspnea, and chest pain. The physical examination, and laboratory and radiological findings are not specific, making the diagnosis difficult, which requires an elevated clinical suspicion.The most accurate noninvasive diagnostic method is indium-111 antimyosin myocardial scintigraphy 4 . This technique is not available in our country. However, another technique of nuclear medicine that uses gallium 67, a marker of inflammation, has been used despite its lower sensitivity and specificity.The endomyocardial biopsy, using Dallas histopathologic criteria, has been the standard diagnostic method, despite its low sensitivity. That technique has been boosted...

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Diagnostic accuracy of antimyosin scintigraphy in suspected myocarditis

Cited by 54 publications

References 31 publications

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

Value of MRI in patients with a clinical suspicion of acute myocarditis

Insuficiência renal aguda após uso de imunoglobulina intravenosa para tratamento de miocardite

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