Long-term outcome of acute myocarditis is independent of cardiac enzyme release

Ammann, Peter; Naegeli, Barbara; Schuiki, Ernst; Straumann, Edwin; Frielingsdorf, Jürgen; Rickli, Hans; Bertel, Osmund

doi:10.1016/s0167-5273(02)00478-3

Cited by 41 publications

(25 citation statements)

References 22 publications

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“…13,14 Previous studies have demonstrated that long-term outcomes in myocarditis, such as normalization of left ventricular function, progression to heart failure, or death, are independent of cardiac enzyme release at the time of diagnosis. [38][39][40] Although our study consisted of a small number of participants, our data support this observation with novel morphological findings using CMR. Indeed, cardiac enzymes had normalized even in patients of our cohort, who were considered high risk based on the LGE extent at 3-month follow-up.…”

Section: Discussionsupporting

confidence: 85%

Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up

Berg

Kottwitz

Baltensperger

et al. 2017

Circ: Heart Failure

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BACKGROUND:There is a major unmet need to identify high-risk patients in myocarditis. Although decreasing cardiac and inflammatory markers are commonly interpreted as resolving myocarditis, this assumption has not been confirmed as of today. We sought to evaluate whether routine laboratory parameters at diagnosis predict dynamic of late gadolinium enhancement (LGE) as persistent LGE has been shown to be a risk marker in myocarditis. METHODS AND RESULTS:Myocarditis was diagnosed based on clinical presentation, high-sensitivity troponin T, and cardiac magnetic resonance imaging, after exclusion of obstructive coronary artery disease by angiography. Cardiac magnetic resonance imaging was repeated at 3 months.LGE extent was analyzed with the software GT Volume. Change in LGE >20% was considered significant. Investigated cardiac and inflammatory markers included high-sensitivity troponin T, creatine kinase, myoglobin, N-terminal B-type natriuretic peptide, C-reactive protein, and leukocyte count. Twenty-four patients were enrolled. Absolute levels of cardiac enzymes and inflammatory markers at baseline did not predict change in LGE at 3 months. Cardiac and inflammatory markers had normalized in 21 patients (88%). LGE significantly improved in 16 patients (67%); however, it persisted to a lesser degree in 17 of them (71%) and increased in a small percentage (21%) despite normalization of cardiac enzymes.CONCLUSIONS: This is the first study reporting that cardiac enzymes and inflammatory parameters do not sufficiently reflect LGE in myocarditis. Although a majority of patients with normalizing laboratory markers experienced improved LGE, in a small percentage LGE worsened. These data suggest that cardiac magnetic resonance imaging might add value to currently existing diagnostic tools for risk assessment in myocarditis. Cardiac Magnetic Resonance Imaging in Myocarditis is a common cardiac disease of varying degree of severity. [1][2][3][4][5] Clinical presentation may range from mild symptoms to severe heart failure and ventricular arrhythmias. 6,7 Myocarditis has been reported in up to 25% of young adults presenting with sudden death. [8][9][10][11][12] As of today, there is a major unmet need to accurately diagnose patients with myocarditis and to identify individuals at highest risk for adverse cardiovascular events. One known indicator of poor outcome is persistent late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR). 13,14 Although cardiac enzymes and inflammatory markers may be elevated in acute myocarditis, 3,7,15,16 their role in predicting disease progression remains unknown. Transcriptomic biomarkers derived from a single endomyocardial biopsy have recently demonstrated promising results as highly accurate diagnostic test for lymphocytic myocarditis. 17,18 However, endomyocardial biopsy is an invasive procedure with the risk of complications and the limitation of sampling error. [19][20][21][22] Furthermore, it can only be performed in experienced centers. Therefore, its use is limit...

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Section: Discussionsupporting

confidence: 85%

Cardiac Magnetic Resonance Imaging in Myocarditis Reveals Persistent Disease Activity Despite Normalization of Cardiac Enzymes and Inflammatory Parameters at 3-Month Follow-Up

Berg

Kottwitz

Baltensperger

et al. 2017

Circ: Heart Failure

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“…In the study by Kobayshi et al, no evidence of myocardial dysfunction was observed in 12 myocarditis patients with elevated cardiac enzymes in the short term [7]. Similarly, in the study by Ammann et al, measurement of troponin I, CK and myoglobin did not predict early and late outcome of the left ventricular EF [8]. Furthermore, serum troponin I levels did not correlate with the histological severity of myocarditis [9,10].…”

Section: Discussionmentioning

confidence: 89%

“…However, in the review of the literature, increased troponin levels do not seem to predict the outcome of left ventricular outcome in myocarditis [5][6][7][8]. In the study by Kobayshi et al, no evidence of myocardial dysfunction was observed in 12 myocarditis patients with elevated cardiac enzymes in the short term [7].…”

Section: Discussionmentioning

confidence: 98%

Marked elevation of troponin I without wall motion abnormality in a patient with myocarditis: Cardiac enzymes may not predict the outcome in myocarditis

Özkök¹,

Atakan²,

Açar³

et al. 2013

OJIM

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A seventeen-year-old male presented with severe substernal chest pain after an episode of upper respiratory tract infection. On clinical grounds, a diagnosis of myocarditis was established. He had a peak troponin I level as high as 40.4 ng/dl but interestingly with no abnormal wall motion and normal ejection fraction in echocardiography. Coronary artery disease was excluded with normal coronary angiography. Diagnosis of myocarditis was confirmed with cardiac MRI. After one month, patient had no complaint and ejection fraction were still normal. Our case emphasizes that the troponin levels predict neither the early nor the late outcome of the left ventricular functions in myocarditis, therefore serum troponin I may not be helpful in determining the prognosis of patients with myocarditis.

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“…Nessa fase ocorre maior dano celular miocárdico. Existe também infiltração de linfócitos B, sendo que a proporção aumenta gradativamente no decorrer do 1 o ao 3 o mês 26 . A resposta imune humoral tem importante papel na lesão e disfunção miocárdica.…”

Section: Fisiopatologiaunclassified