Myokarditis in der Differenzialdiagnose von Kardiomyopathien

Abstract

Myocarditis is an inflammatory disease of the heart muscle commonly caused by viral pathogens. Dilated cardiomyopathy is a major long-term sequela of myocarditis and at least in part related to post-viral immune-mediated responses. Establishing a diagnosis of myocarditis represents a major challenge because of the variable clinical picture and the lack of readily available, non-invasive diagnostic tests. In recent years, cardiac magnetic resonance imaging (cMRI) has emerged as a promising additional diagnostic tool in patients with suspected myocarditis: cMRI not only provides important insights into structural and functional abnormalities of the heart but relevant tissue pathologies can also be visualized. The diagnostic accuracy of three tissue criteria, i.e. the edema ratio, early gadolinium enhancement ratio and late gadolinium enhancement, has been characterized in several studies. Endomyocardial biopsy (EMB) is widely considered to be the reference standard for diagnosis of myocarditis. Although limited by sampling error, EMB is the only diagnostic procedure that can be used to confirm myocarditis. Laboratory analyses of EMB may provide information about specific causes of myocarditis and are, at least in part, of prognostic relevance. In a subset of patients the results of EMB may guide therapeutic decision-making. Additional efforts are needed in cardiac imaging, molecular characterization of EMB and evaluation of serum biomarkers to improve the diagnostic work-up in patients with suspected myocarditis and to identify potential novel targets for a cause-specific therapy of myocarditis.

Parvovirus B19 Myocarditis of Fulminant Evolution

“…The diagnostic accuracy is based on three tissue criteria (edema ratio, early gadolinium enhancement ratio and late gadolinium enhancement) [8, 9]. CMR provides an assessment of myocardial edema, detection of inflammation, detailed evaluation of left and right ventricular function, “a noninvasive myocardial biopsy”, detection of very small pericardial effusion and “a non-invasive follow-up” [8, 9]. Mahrholdt et al demonstrated that LGE on approximately 10 min of gadolinium administration appears to correlate well with segments of histologically proven myocarditis [5, 9].…”

Pediatrik metabolik hastalıklarda kardiyovasküler bulgular

“…Erken yaşta elde edilecek genetik altyapı bilgisi öngörülen klinik fenotipe göre her hastaya daha bireyselleştirilmiş bir yaklaşım ve genetik danışmanlık için olanak sağlar [2,3]. [50][51][52][53].…”