Reversible impairment of coronary flow reserve in acute myocarditis

Kellermair, Joerg; Kiblboeck, Daniel; Blessberger, Hermann; Kammler, Jürgen; Reiter, Christian; Steinwender, Clemens

doi:10.1111/micc.12491

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…Reduced coronary flow reserve (CFR) was characterized by higher levels of cardiac troponin T and larger areas of LGE on CMR. 16 The correlation of HsTn with myocardial damage has been examined in several studies following myocardial infarction. These studies showed a positive correlation of the infarct size demonstrated on CMR with troponin I levels (r ¼ 0.65, P < 0.0001), 17 although there was an inferior correlation with HsTnI (r ¼ 0.49, P < 0.001) as opposed to HsTnT (r ¼ 0.84, P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

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Correlations between high sensitive troponin I and acute myocarditis extent in cardiac magnetic resonance imaging

Marcusohn¹,

Barbara²,

Epstein

et al. 2023

Journal of Cardiovascular Medicine

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PurposeTo assess the correlation between high sensitive troponin I (HsTnI) levels and myocardial damage on cardiac magnetic resonance (CMR) represented by late gadolinium enhancement (LGE) percentage in patients diagnosed with myocarditis.MethodsRetrospective analysis of consecutive patients who underwent CMR following a suspected diagnosis of acute myocarditis, comparing CMR findings viewed as LGE percentage and HsTnI levels.ResultsBetween February 2016 and December 2021, 101 patients underwent CMR for suspected myocarditis in Rambam Medical Center. Seventy-six (75.2%) patients with a documented diagnosis of acute myocarditis in the medical records based on clinical history and lab work were included in the final analysis. The median age was 30 years [interquartile range (IQR) 22,42] and 62 patients (81.6%) were male. Thirty-four patients (44.7%) had a history of fever and 26 (34.2%) had upper respiratory tract symptoms. The median maximal HsTnI was 3935 ng/l (1165,10 380) and the median C-reactive protein (CRP) was 7.97 mg/l (2.35,19.28). The median LGE percentage was 4.65% (2.6,8.5) and ventricular ejection fraction 60% (56.00,64.75).Linear association was found between LGE (%) and maximal HsTnI (ng/l) value with r = 0.49 (P < 0.001). After including only patients in whom the CMR was performed within 5 days of the maximal HsTnI the correlation improved to r = 0.67 (P < 0.001).ConclusionsHsTnI is an indicator for myocardial damage extent resulting from inflammation in patients with acute myocarditis.

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Section: Discussionmentioning

confidence: 99%

“…Qualitative and quantitative CMR methods boast similar accuracy for the diagnosis of acute myocarditis, 15 and its correlation with troponin has been studied with respect to the coronary flow of microcirculation. Reduced coronary flow reserve (CFR) was characterized by higher levels of cardiac troponin T and larger areas of LGE on CMR 16 …”

Section: Discussionmentioning

confidence: 99%

Correlations between high sensitive troponin I and acute myocarditis extent in cardiac magnetic resonance imaging

Marcusohn¹,

Barbara²,

Epstein

et al. 2023

Journal of Cardiovascular Medicine

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“…That said, the presence and clinical significance of myocardial microvasculature compromise in surviving MIS‐c patients should be further investigated in the long term. It is of paramount importance to evaluate the effects of superimposed cardiovascular risk factors in this particular population, such as obesity, dyslipidemia, smoking, and systemic hypertension, which are known to impact myocardial microvascular functionality as well 23 . Understanding the key dysregulated cascade triggered by COVID‐19 in the vascular system of MIS‐c patients provides information on mediators of the pathologic process, which may help tailor successful therapeutic interventions, reducing short‐ and long‐term morbidity and mortality 21 …”

Section: Discussionmentioning

confidence: 99%

“…In the context of acute myocarditis induced by SARS‐CoV‐2, different inflammatory cells invade the myocardial architecture, release cytokines, growth factors and impair coronary microcirculation. The vascular tone of coronary microvessels is physiologically regulated by myogenic, neural, metabolic, and endothelial mechanisms, according to local demands 23 . Myocardial inflammation interferes with this precisely regulated system, induces endothelial dysfunction and microcirculatory disturbances, which finally results in myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Segmental cardiac strain assessment by two‐dimensional speckle‐tracking echocardiography in surviving MIS‐c patients: Correlations with myocardial flow reserve (MFR) by 13 N‐ammonia PET‐CT

Leal

Astley

Lima³

et al. 2022

Microcirculation

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Background Multisystem inflammatory syndrome in children (MIS‐c) is associated with severe cardiovascular impairment and eventually death. Pathophysiological mechanisms involved in myocardial injury were scarcely investigated, and cardiovascular outcomes are uncertain. Autopsy studies suggested that microvascular dysfunction may be relevant to LV impairment. Objective We aimed to evaluate segmental LV longitudinal strain by 2DST echocardiography and myocardial flow reserve (MFR) by 13 N‐ammonia PET‐CT, in six surviving MIS‐c patients. Methods Each patient generated 34 LV segments for combined 2DST and MRF analysis. MFR was considered abnormal when <2, borderline when between 2 and 2.5 and normal when >2.5. Results From July 2020 to February 2021, six patients were admitted with MIS‐c: three males, aged 9.3 (6.6–15.7) years. Time from admission to the follow‐up visit was 6.05 (2–10.3) months. Although all patients were asymptomatic and LV EF was ≥55%, 43/102 (42.1%) LV segments showed MFR <2.5. There was a modest positive correlation between segmental peak systolic longitudinal strain and MFR: r = .36, p = .03 for basal segments; r = .41, p = .022 for mid segments; r = .42, p = .021 for apical segments. Median peak systolic longitudinal strain was different among MRF categories: 18% (12%–24%) for abnormal, 18.5% (11%–35%) for borderline, and 21% (12%–32%) for normal MFR (p = .006). Conclusion We provided preliminary evidence that surviving MIS‐c patients may present subclinical impairment of myocardial microcirculation. Segmental cardiac strain assessment 2DST seems useful for MIS‐c cardiovascular follow‐up, given its good correlation with 13 N‐ammonia PET‐CT derived MFR.

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“…These patients had higher levels of cardiac troponin T and larger areas of late gadolinium enhancement at cardiac magnetic resonance. Interestingly, at three-month follow-up TTDE, CFVR was normal in all patients [86]. Within the field of renal disease, TTDE has been used to assess CFVR in patients with nephrotic syndrome.…”

Section: Other Inflammatory Conditionsmentioning

confidence: 98%

Coronary Flow Velocity Reserve by Echocardiography: Beyond Atherosclerotic Disease

et al. 2023

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Coronary flow velocity reserve (CFVR) is defined as the ratio between coronary flow velocity during maximal hyperemia and coronary flow at rest. Gold-standard techniques to measure CFVR are either invasive or require radiation and are therefore inappropriate for large-scale adoption. More than 30 years ago, echocardiography was demonstrated to be a reliable tool to assess CFVR, and its field of application rapidly expanded. Although initially validated to assess the hemodynamic relevance of a coronary stenosis, CFVR by echocardiography was later used to investigate coronary microcirculation. Microvascular dysfunction was detected in many different conditions, ranging from organ transplantation to inflammatory disorders and from metabolic diseases to cardiomyopathies. Moreover, it has been proven that CFVR by echocardiography not only detects coronary microvascular involvement but is also an effective prognostic factor that allows a precise risk stratification of the patients. In this review, we will summarize the many applications of CFVR by echocardiography, focusing on the coronary involvement of systemic diseases.

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Reversible impairment of coronary flow reserve in acute myocarditis

Abstract: A reversibly impaired coronary microcirculation is a frequent finding in acute myocarditis and is associated with markers of inflammation severity. Echocardiographic CFR measurement represents a feasible and safe method for its assessment.

Cited by 3 publications

References 23 publications

Correlations between high sensitive troponin I and acute myocarditis extent in cardiac magnetic resonance imaging

Correlations between high sensitive troponin I and acute myocarditis extent in cardiac magnetic resonance imaging

Segmental cardiac strain assessment by two‐dimensional speckle‐tracking echocardiography in surviving MIS‐c patients: Correlations with myocardial flow reserve (MFR) by 13 N‐ammonia PET‐CT

Coronary Flow Velocity Reserve by Echocardiography: Beyond Atherosclerotic Disease

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