Presentation, Patterns of Myocardial Damage, and Clinical Course of Viral Myocarditis

Mahrholdt, Heiko; Wagner, Anja; Deluigi, Claudia C.; Kispert, Eva; Häger, Stefan; Meinhardt, Gabriel; Vogelsberg, Holger; Fritz, Péter; Dippon, Juergen; Bock, C.‐Thomas; Klingel, Karin; Kandolf, Reinhard; Sechtem, Udo

doi:10.1161/circulationaha.105.606509

Cited by 771 publications

(642 citation statements)

References 46 publications

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“…U94/REP maintained the anti-angiogenic properties also in this assay. These observations are particularly relevant considering that recent reports describe the presence of HHV-6 DNA in myocardial diseases and cardiac dysfunctions (23,24). A hypothesis that remains to be tested is that also in vivo HHV-6 might be latent in ECs and express U94/REP, significantly impairing physiological angiogenesis, either contributing to the disease or preventing recovery.…”

Section: Discussionmentioning

confidence: 97%

U94 of human herpesvirus 6 inhibits in vitro angiogenesis and lymphangiogenesis

Caruso

Caselli

Fiorentini

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

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Section: Discussionmentioning

confidence: 97%

U94 of human herpesvirus 6 inhibits in vitro angiogenesis and lymphangiogenesis

Caruso

Caselli

Fiorentini

et al. 2009

Proc. Natl. Acad. Sci. U.S.A.

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“…The T2-weighted images show hyperintense subepicardial and midwall areas of myocardial oedema. 51 LGE is typically seen more pronounced in the subepicardial areas in inferolateral segments. Finally, hyperaemia and capillary leak (visualised on CMR images acquired early after gadolinium injection) have shown to be the best predictor in patients with chronic myocarditis.…”

Section: Cardiovascular Magnetic Resonance In Other Cardiomyopathiesmentioning

confidence: 99%

Novel Imaging Techniques for Heart Failure

Melero-Ferrer

López‐Vilella

Morillas-Climent

et al. 2016

Cardiac Failure Review

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Heart failure (HF) is an epidemic with an increasing prevalence and an absolute mortality rate of approximately 50 % within 5 years of diagnosis. Imaging plays a main role in HF diagnosis, assessment of aetiology and treatment guidance. This article reviews current HF applications for all the available non-invasive imaging modalities: echocardiography, cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT). Echocardiography, with its recent developments, such as 3D echo, is the main imaging test used in the evaluation of HF patients, given its availability and reliability in assessing cardiac structure and function. CMR allows the characterisation of myocardial tissue, in addition to providing information on the structure and cardiac function, so it is a great help in the determination of HF aetiology and may predict patient outcomes. Nuclear imaging can detect ischaemia and viability and can obtain additional prognostic data. Cardiac CT is EchocardiographyAlthough echocardiography is a relatively 'ancient' technique, its versatility makes it unique in the provision of volumes, function, haemodynamics or valvular regurgitation. In addition, because of its availability, safety and low cost, echocardiography is the first and most widely used test for the diagnosis, selection of appropriate treatment and prognosis of HF.1 Echocardiography is also the most used imaging method in the reassessment of HF patients. It remains unclear when to repeat echocardiographic exams, but it is deemed appropriate at least in patients with worsening symptoms. Systolic FunctionGlobal left ventricular (LV) function is of paramount importance regarding therapeutic decisions. Visual estimation of ejection fraction (EF), the Teichholz and Simpson methods, have been widely validated. 2,3However, in 2D imaging, because of its operator-dependent nature, repeated testing has a high probability of producing variable volume and EF results.The apparition of 3D fully sampled matrix transthoracic echocardiography has enabled easier acquisition of images, 4 simplifying its routinary application. There have been many studies comparing 2D and 3D echocardiography (2DE and 3DE) and a 'reference' standard (generally CMR). A recent meta-analysis of all 3DE studies evaluating LV volumes and EF demonstrated that 3DE generally underestimated volumes, but not as significantly as 2DE. There was also less variability than 2D compared with CMR.5 Nonetheless, 3DE echocardiography may be challenging and not practical in patients with low image quality (e.g. critical patients), in whom 2DE measures are more realiable. 3DE is also a less standardised techique than 2DE, and because of this reason most laboratories use the more universally applicable 2DE measurements in clinical practice. Only recently, large analyses of LV parameters using 3DE in large cohorts of healthy individuals have been published to establish race, age and gender-specific ...

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“…2 -5 This pattern of clinical presentation has been related to parvovirus B19 infection of the endothelial cells of myocardial vessels, causing endothelial dysfunction and coronary vasospasm, migration of inflammatory cells into the myocardial interstitium, and subsequent myocyte damage. 21,22 Cardiac MRI with the LGE technique has emerged as an important tool for the diagnostic workup of these patients, noninvasively distinguishing AM from ischemic injury and other nonischemic conditions with infarctlike presentation, such as Takotsubo cardiomyopathy. 7 Following a myocardial infarction, LGE with subendocardial or transmural pattern is typical.…”

Section: Electrocardiography In Infarct-like Myocarditis and Relationmentioning

confidence: 99%

Infarct‐like Acute Myocarditis: Relation Between Electrocardiographic Findings and Myocardial Damage as Assessed by Cardiac Magnetic Resonance Imaging

Nucifora¹,

Miani²,

Chiara³

et al. 2012

Clinical Cardiology

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Background: Acute myocarditis (AM) may occasionally have an infarct-like presentation. The aim of the present study was to investigate the relation between electrocardiographic (ECG) findings in this group of patients and myocardial damage assessed by cardiac magnetic resonance imaging (MRI) with the late gadolinium enhancement (LGE) technique. Hypothesis: Myocardial damage may be associated with ECG changes in infarct-like AM. Methods: Forty-one consecutive patients (36 males; mean age, 36 ± 12 years) with diagnosis of AM according to cardiac MRI Lake Louise criteria and infarct-like presentation were included. The relation between site of ST-segment elevation (STE), sum of STE (sumSTE), time to normalization of STE, and development of negative T wave with the extent of LGE (expressed as % of left ventricular mass [%LV LGE]), was evaluated. Results: Most (80%) patients presented with inferolateral STE; mean sumSTE was 5 ± 3 mm. Normalization of STE occurred within 24 hours in 20 (49%) patients. Development of negative T wave occurred in 28 (68%) patients. Cardiac MRI showed LGE in all patients; mean %LV LGE was 9.6 ± 7.2%. Topographic agreement between site of STE and LGE was 68%. At multivariate analysis, sumSTE (β = 0.42, P < 0.001), normalization of STE >24 hours (β = 0.39, P < 0.001), and development of negative T wave (β = 0.49, P < 0.001) were independently related to %LV LGE. Conclusions: Analysis of the site of STE underestimates the extent of myocardial injury among patients with infarct-like myocarditis. However, some ECG features (ie, sumSTE, normalization of STE >24 hours, and development of negative T wave) may help to identify patients with larger areas of myocardial damage.

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Presentation, Patterns of Myocardial Damage, and Clinical Course of Viral Myocarditis

Cited by 771 publications

References 46 publications

U94 of human herpesvirus 6 inhibits in vitro angiogenesis and lymphangiogenesis

U94 of human herpesvirus 6 inhibits in vitro angiogenesis and lymphangiogenesis

Novel Imaging Techniques for Heart Failure

Infarct‐like Acute Myocarditis: Relation Between Electrocardiographic Findings and Myocardial Damage as Assessed by Cardiac Magnetic Resonance Imaging

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