Multiparametric Cardiovascular Magnetic Resonance in Acute Myocarditis: Comparison of 2009 and 2018 Lake Louise Criteria With Endomyocardial Biopsy Confirmation

Li, Shuang; Duan, Xuejing; Feng, Guangxun; Sirajuddin, Arlene; Yin, Gang; Zhuang, Baiyan; He, Jian; Xu, Jing; Yang, Wenjing; Wu, Wenzhi; Sun, Xiaokang; Zhao, Shihua; Wang, Hongyue; Zhang, Teng; Lü, Ming-De

doi:10.3389/fcvm.2021.739892

Cited by 18 publications

(15 citation statements)

References 27 publications

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“…EMB is the golden standard for histological diagnosis of myocarditis, but it is an invasive method with limitations such as serious procedure-related complications or sampling errors. With an excellent diagnostic accuracy of CMR in acute myocarditis due to great advances in imaging technology, the usefulness of non-invasive CMR alone in diagnosing acute myocarditis has been widely reported ( 52 , 58 , 59 ). Therefore, a single approach of either CMR or EMB is now considered sufficient for the diagnosis of acute myocarditis.…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Challenge of Eosinophilic Granulomatosis With Polyangiitis Presenting as Acute Eosinophilic Myocarditis: Case Report and Literature Review

Yamamoto

HASHIMOTO

Ikeda

et al. 2022

Front. Cardiovasc. Med.

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Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis involving small-to-medium-sized vessels characterized by asthma, vasculitis, and peripheral eosinophilia. EGPA-associated eosinophilic myocarditis (EM) occurs rarely, yet can be fatal if left untreated. Moreover, the accurate diagnosis of EGPA-associated EM without vasculitis is exceptionally difficult because of the overlapping features with EM of other causes. We report a case of probable EGPA with subclinical neurological involvement that presented with acute EM. The constellation of peripheral eosinophilia, left ventricular dysfunction, and normal epicardial coronary arteries raised suspicion of acute EM, which was confirmed by cardiac magnetic resonance (CMR) investigation and endomyocardial biopsy (EMB). Prompt systemic administration of corticosteroids completely restored and normalized myocardial structure and function. Although the patient's history suggested the presumed hypersensitivity myocarditis, EMB revealed EM without vasculitis, not hypersensitivity, leading to a tentative diagnosis of idiopathic hypereosinophilic syndrome. Interestingly, the characteristic findings of vasculitis on CMR imaging strongly suggested EGPA-associated EM. Although the patient had no clinical neurological manifestations, a nerve conduction study confirmed mononeuritis multiplex, leading to the final diagnosis of probable EGPA. Therefore, this case highlights the diagnostic challenge associated with EGPA and the diagnostic synergy of CMR and EMB for an exploratory diagnosis of EGPA-associated EM.

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Section: Discussionmentioning

confidence: 99%

The Diagnostic Challenge of Eosinophilic Granulomatosis With Polyangiitis Presenting as Acute Eosinophilic Myocarditis: Case Report and Literature Review

Yamamoto

HASHIMOTO

Ikeda

et al. 2022

Front. Cardiovasc. Med.

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Section: Lake Louise Criteria For Noninvasive Detection Of Myocardial...mentioning

confidence: 99%

Imaging Methods: Magnetic Resonance Imaging

Thomas

Fotaki

Botnar

et al. 2023

Circ: Cardiovascular Imaging

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Myocardial inflammation occurs following activation of the cardiac immune system, producing characteristic changes in the myocardial tissue. Cardiovascular magnetic resonance is the non-invasive imaging gold standard for myocardial tissue characterization, and is able to detect image signal changes that may occur resulting from inflammation, including edema, hyperemia, capillary leak, necrosis, and fibrosis. Conventional cardiovascular magnetic resonance for the detection of myocardial inflammation and its sequela include T2-weighted imaging, parametric T1- and T2-mapping, and gadolinium-based contrast-enhanced imaging. Emerging techniques seek to image several parameters simultaneously for myocardial tissue characterization, and to depict subtle immune-mediated changes, such as immune cell activity in the myocardium and cardiac cell metabolism. This review article outlines the underlying principles of current and emerging cardiovascular magnetic resonance methods for imaging myocardial inflammation.

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“…ECV can identify diffuse myocardial fibrosis at the early stage of hypertensive cardiomyopathy, before the appearance of LGE ( 120 ) ( Figure 2 ). T1 mapping is also included in the updated Lake Louise Criteria (CMR consensus recommendations for myocarditis) in 2018 to detect edema and reactive fibrosis during the early inflammatory phases ( 121 ) and it can significantly improve the diagnostic ability of CMR for acute myocarditis ( 122 ).…”

Section: Detection: Laboratory Biomarkers and Imaging Techniquesmentioning

confidence: 99%

Detection of myocardial fibrosis: Where we stand

Zhu

Zhao

Lü

2022

Front. Cardiovasc. Med.

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Myocardial fibrosis, resulting from the disturbance of extracellular matrix homeostasis in response to different insults, is a common and important pathological remodeling process that is associated with adverse clinical outcomes, including arrhythmia, heart failure, or even sudden cardiac death. Over the past decades, multiple non-invasive detection methods have been developed. Laboratory biomarkers can aid in both detection and risk stratification by reflecting cellular and even molecular changes in fibrotic processes, yet more evidence that validates their detection accuracy is still warranted. Different non-invasive imaging techniques have been demonstrated to not only detect myocardial fibrosis but also provide information on prognosis and management. Cardiovascular magnetic resonance (CMR) is considered as the gold standard imaging technique to non-invasively identify and quantify myocardial fibrosis with its natural ability for tissue characterization. This review summarizes the current understanding of the non-invasive detection methods of myocardial fibrosis, with the focus on different techniques and clinical applications of CMR.

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Multiparametric Cardiovascular Magnetic Resonance in Acute Myocarditis: Comparison of 2009 and 2018 Lake Louise Criteria With Endomyocardial Biopsy Confirmation

Cited by 18 publications

References 27 publications

The Diagnostic Challenge of Eosinophilic Granulomatosis With Polyangiitis Presenting as Acute Eosinophilic Myocarditis: Case Report and Literature Review

The Diagnostic Challenge of Eosinophilic Granulomatosis With Polyangiitis Presenting as Acute Eosinophilic Myocarditis: Case Report and Literature Review

Imaging Methods: Magnetic Resonance Imaging

Detection of myocardial fibrosis: Where we stand

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