PMID- 21106555
OWN - NLM
STAT- MEDLINE
DCOM- 20111019
LR  - 20220408
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 97
IP  - 16
DP  - 2011 Aug
TI  - Acute myocarditis presenting as acute coronary syndrome: role of early cardiac 
      magnetic resonance in its diagnosis.
PG  - 1312-8
LID - 10.1136/hrt.2010.204818 [doi]
AB  - BACKGROUND: In patients presenting with acute cardiac symptoms, abnormal ECG and 
      raised troponin, myocarditis may be suspected after normal angiography. AIMS: To 
      analyse cardiac magnetic resonance (CMR) findings in patients with a provisional 
      diagnosis of acute coronary syndrome (ACS) in whom acute myocarditis was 
      subsequently considered more likely. METHODS AND RESULTS: 79 patients referred 
      for CMR following an admission with presumed ACS and raised serum troponin in 
      whom no culprit lesion was detected were studied. 13% had unrecognised myocardial 
      infarction and 6% takotsubo cardiomyopathy. The remainder (81%) were diagnosed 
      with myocarditis. Mean age was 45+/-15 years and 70% were male. Left ventricular 
      ejection fraction (EF) was 58+/-10%; myocardial oedema was detected in 58%. A 
      myocarditic pattern of late gadolinium enhancement (LGE) was detected in 92%. 
      Abnormalities were detected more frequently in scans performed within 2 weeks of 
      symptom onset: oedema in 81% vs 11% (p<0.0005), and LGE in 100% vs 76% (p<0.005). 
      In 20 patients with both an acute (<2 weeks) and convalescent scan (>3 weeks), 
      oedema decreased from 84% to 39% (p<0.01) and LGE from 5.6 to 3.0 segments 
      (p=0.005). Three patients presented with sustained ventricular tachycardia, 
      another died suddenly 4 days after admission and one resuscitated 7 weeks 
      following presentation. All 5 patients had preserved EF. CONCLUSIONS: Our study 
      emphasises the importance of access to CMR for heart attack centres. If 
      myocarditis is suspected, CMR scanning should be performed within 14 days. 
      Myocarditis should not be regarded as benign, even when EF is preserved.
FAU - Monney, Pierre A
AU  - Monney PA
AD  - Barts and The London NHS Trust, UK.
FAU - Sekhri, Neha
AU  - Sekhri N
FAU - Burchell, Thomas
AU  - Burchell T
FAU - Knight, Charles
AU  - Knight C
FAU - Davies, Ceri
AU  - Davies C
FAU - Deaner, Andrew
AU  - Deaner A
FAU - Sheaf, Michael
AU  - Sheaf M
FAU - Baithun, Suhail
AU  - Baithun S
FAU - Petersen, Steffen
AU  - Petersen S
FAU - Wragg, Andrew
AU  - Wragg A
FAU - Jain, Ajay
AU  - Jain A
FAU - Westwood, Mark
AU  - Westwood M
FAU - Mills, Peter
AU  - Mills P
FAU - Mathur, Anthony
AU  - Mathur A
FAU - Mohiddin, Saidi A
AU  - Mohiddin SA
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20101123
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Biomarkers)
RN  - 0 (Contrast Media)
RN  - 0 (Troponin)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - Heart. 2011 Aug;97(16):1283. PMID: 21487125
MH  - Acute Coronary Syndrome/*diagnosis
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Biomarkers/blood
MH  - Contrast Media
MH  - Diagnosis, Differential
MH  - Edema, Cardiac/diagnosis
MH  - Female
MH  - Gadolinium
MH  - Humans
MH  - Magnetic Resonance Imaging/methods
MH  - Male
MH  - Middle Aged
MH  - Myocarditis/*diagnosis
MH  - Sensitivity and Specificity
MH  - Time Factors
MH  - Troponin/blood
MH  - Young Adult
EDAT- 2010/11/26 06:00
MHDA- 2011/10/20 06:00
CRDT- 2010/11/26 06:00
PHST- 2010/11/26 06:00 [entrez]
PHST- 2010/11/26 06:00 [pubmed]
PHST- 2011/10/20 06:00 [medline]
AID - hrt.2010.204818 [pii]
AID - 10.1136/hrt.2010.204818 [doi]
PST - ppublish
SO  - Heart. 2011 Aug;97(16):1312-8. doi: 10.1136/hrt.2010.204818. Epub 2010 Nov 23.