PMID- 19356545
OWN - NLM
STAT- MEDLINE
DCOM- 20090706
LR  - 20191210
IS  - 1876-7591 (Electronic)
IS  - 1876-7591 (Linking)
VI  - 2
IP  - 2
DP  - 2009 Feb
TI  - Cardiac magnetic resonance monitors reversible and irreversible myocardial injury 
      in myocarditis.
PG  - 131-8
LID - 10.1016/j.jcmg.2008.09.014 [doi]
AB  - OBJECTIVES: We sought to assess the value of cardiac magnetic resonance (CMR) to 
      monitor the spectrum of myocarditis-related injuries over the course of the 
      disease. BACKGROUND: Myocarditis is associated with a wide range of myocardial 
      tissue injuries, both reversible and irreversible. Differentiating these types of 
      injuries is a clinical demand. METHODS: We studied 36 patients (31 males, age 33 
      +/- 14 years) hospitalized with myocarditis during the acute phase and 18 +/- 10 
      months thereafter. CMR was performed on 2 1.5T scanners and included the 
      following techniques: steady-state free precession (to assess left ventricular 
      function and volumes), T2-weighted (myocardial edema), early (global relative 
      enhancement [gRE], reflecting increased capillary leakage) and late T1-weighted 
      after gadolinium-DTPA injection (late gadolinium enhancement [LGE], reflecting 
      irreversible injury). RESULTS: In the acute phase, T2 ratio was elevated in 86%, 
      gRE in 80%, and LGE was present in 63%. At follow-up, ejection fraction increased 
      from 56 +/- 8% to 62 +/- 7% (p < 0.0001) while both T2 ratio (2.4 +/- 0.5 to 1.9 
      +/- 0.2; p < 0.0001) and gRE (7.6 +/- 8 to 4.4 +/- 4; p = 0.018) significantly 
      decreased. LGE persisted in all but 1 patient in whom LGE completely resolved. No 
      patient had simultaneous elevation of T2 and gRE during the convalescent phase, 
      resulting in a negative predictive value of 100% to differentiate the 2 phases of 
      the disease. The acute phase T2 ratio correlated significantly with the change of 
      end-diastolic volume over time (beta = 0.47; p = 0.008). This relation remained 
      significant in a stepwise regression analysis model including T2 ratio, gRE, LGE 
      extent, baseline ejection fraction, age, and creatine kinase, in which only T2 
      emerged as an independent predictor of the change in end-diastolic volume. 
      CONCLUSIONS: A comprehensive CMR approach is a useful tool to monitor the 
      reversible and irreversible myocardial tissue injuries over the course of 
      myocarditis and to differentiate acute from healed myocarditis in patients with 
      still-preserved ejection fraction.
FAU - Zagrosek, Anja
AU  - Zagrosek A
AD  - Franz-Volhard-Klinik, Kardiologie, Charite Campus Buch, HELIOS-Klinikum Berlin, 
      Universitatsmedizin Berlin, Berlin, Germany.
FAU - Abdel-Aty, Hassan
AU  - Abdel-Aty H
FAU - Boye, Philipp
AU  - Boye P
FAU - Wassmuth, Ralf
AU  - Wassmuth R
FAU - Messroghli, Daniel
AU  - Messroghli D
FAU - Utz, Wolfgang
AU  - Utz W
FAU - Rudolph, Andre
AU  - Rudolph A
FAU - Bohl, Steffen
AU  - Bohl S
FAU - Dietz, Rainer
AU  - Dietz R
FAU - Schulz-Menger, Jeanette
AU  - Schulz-Menger J
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Contrast Media)
RN  - K2I13DR72L (Gadolinium DTPA)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2009 Feb;2(2):139-42. PMID: 19356546
MH  - Adult
MH  - Capillary Permeability
MH  - Contrast Media
MH  - Diagnosis, Differential
MH  - Disease Progression
MH  - Edema, Cardiac/etiology/pathology
MH  - Female
MH  - Follow-Up Studies
MH  - Gadolinium DTPA
MH  - Humans
MH  - *Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Myocarditis/complications/*pathology/physiopathology
MH  - Myocardium/*pathology
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Stroke Volume
MH  - Time Factors
MH  - Ventricular Function, Left
MH  - Young Adult
EDAT- 2009/04/10 09:00
MHDA- 2009/07/07 09:00
CRDT- 2009/04/10 09:00
PHST- 2008/06/17 00:00 [received]
PHST- 2008/08/29 00:00 [revised]
PHST- 2008/09/09 00:00 [accepted]
PHST- 2009/04/10 09:00 [entrez]
PHST- 2009/04/10 09:00 [pubmed]
PHST- 2009/07/07 09:00 [medline]
AID - S1936-878X(08)00466-X [pii]
AID - 10.1016/j.jcmg.2008.09.014 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2009 Feb;2(2):131-8. doi: 10.1016/j.jcmg.2008.09.014.