Transcriptomic Biomarkers for the Accurate Diagnosis of Myocarditis

Heidecker, Bettina; Kittleson, M.; Kasper, Edward K.; Wittstein, Ilan S.; Champion, Hunter C.; Russell, Stuart D.; Hruban, Ralph H.; Rodríguez, E. René; Baughman, Kenneth L.; Hare, Joshua M.

doi:10.1161/circulationaha.110.002857

Cited by 86 publications

(64 citation statements)

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“…The Dallas criteria may also be limited in the detection of myocarditis from viruses such parvovirus B19 and human herpesvirus 6, in which the primary pathology resides in endothelial injury. 4 54 developed an assay of transcriptomic biomarkers from a single biopsy sample to diagnose myocarditis with a high degree of accuracy. These techniques, if confirmed, could substantially change diagnostic algorithms for the detection of myocarditis.…”

Section: Diagnosis and Therapy For Myocarditis In Children 117mentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

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Section: Diagnosis and Therapy For Myocarditis In Children 117mentioning

confidence: 99%

Diagnosis and Treatment of Myocarditis in Children in the Current Era

2014

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“…Transcriptome-based analysis of biopsies may further our definition of myocarditis. 5 Patients of suspected myocarditis are clinically evaluated to distinguish fulminant lymphocytic myocarditis from acute lymphocytic myocarditis. In the case of fulminant myocarditis, patients exhibit New York Heart Association class IV symptoms, such as flu-like symptoms with left ventricle (LV) systolic dysfunction and cardiogenic shock.…”

Section: Definitionsmentioning

confidence: 99%

Myocarditis

Gabriel

Luo

Qiu

et al. 2016

Circulation Research

412

354

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“…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.…”

mentioning

confidence: 99%

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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Transcriptomic Biomarkers for the Accurate Diagnosis of Myocarditis

Cited by 86 publications

References 50 publications

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Diagnosis and Treatment of Myocarditis in Children in the Current Era

Myocarditis

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

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