PMID- 25315045
OWN - NLM
STAT- MEDLINE
DCOM- 20151008
LR  - 20211021
IS  - 1861-0692 (Electronic)
IS  - 1861-0684 (Linking)
VI  - 104
IP  - 2
DP  - 2015 Feb
TI  - Diagnostic value of CMR in young patients with clinically suspected acute 
      myocarditis is determined by cardiac enzymes.
PG  - 154-63
LID - 10.1007/s00392-014-0770-7 [doi]
AB  - AIMS: Cardiovascular magnetic resonance (CMR) has become a valuable diagnostic 
      tool for non-invasive diagnosis of acute myocarditis. However, since CMR studies 
      are time- and cost-intensive and its diagnostic accuracy still not perfect, 
      additional parameters are warranted to preselect and identify those individuals 
      in whom a CMR study is likely to add crucial information regarding correct and 
      timely diagnosis of acute myocarditis. The diagnostic value of CMR was evaluated 
      in a population of young patients with clinically suspected acute myocarditis in 
      relation to ECG and serum cardiac enzyme findings. METHODS AND RESULTS: Only 
      young patients aged </= 40 years in whom acute myocarditis was highly suspected 
      based on their clinical symptoms, resting ECG findings and/or levels of cardiac 
      enzymes (at presentation) were included to this study. After ruling out 
      obstructive coronary artery disease, a multi-parametric CMR study was performed 
      as part of the diagnostic work-up. The CMR protocol comprised cine sequences, 
      T2-weighted edema imaging and late gadolinium enhancement (LGE) imaging on a 
      1.5-T MR scanner. 89 patients (28 +/- 7 years, 89 % male) were included to this 
      study presenting with symptoms of chest pain (85 %), dyspnea (26 %), fatigue (23 
      %) and/or palpitations (18 %). Pathological ECG changes were present in 72 
      patients (81 %). An elevated serum troponin level was measured in 45 patients (51 
      %). Pathological CMR findings (presence of edema and/or LGE) were detected in 35 
      patients (39 %). In detail, pathological CMR findings were detected in 36 % of 
      patients with resting ECG changes and in 73 % of patients with troponin rise. In 
      contrast, normal CMR results were obtained in 95 % of patients with negative 
      troponin at presentation, but only in 41 % of patients with normal ECG. On 
      multivariable analysis, a positive serum troponin was the only independent 
      predictor for a pathological CMR finding (OR = 33.26, 95 % CI = 3.04-363.35, p = 
      0.004). CONCLUSIONS: The clinical use of non-invasive CMR in the work-up of 
      clinically suspected "acute" myocarditis in young patients is only helpful and 
      appropriately indicated in those ones with elevated cardiac enzymes. A 
      pre-selection of such patients for CMR based on serum cardiac enzymes--but not on 
      ECG recordings--may prevent a meaningless overuse of CMR.
FAU - Florian, Anca
AU  - Florian A
AD  - Department of Cardiology and Angiology, University Hospital Munster, 
      Albert-Schweitzer-Campus 1, Building A1, 48149, Munster, Germany.
FAU - Schaufele, Tim
AU  - Schaufele T
FAU - Ludwig, Anna
AU  - Ludwig A
FAU - Rosch, Sabine
AU  - Rosch S
FAU - Wenzelburger, Ina
AU  - Wenzelburger I
FAU - Yildiz, Handan
AU  - Yildiz H
FAU - Sechtem, Udo
AU  - Sechtem U
FAU - Yilmaz, Ali
AU  - Yilmaz A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20141015
PL  - Germany
TA  - Clin Res Cardiol
JT  - Clinical research in cardiology : official journal of the German Cardiac Society
JID - 101264123
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
RN  - EC 2.7.3.2 (Creatine Kinase, MB Form)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Biomarkers/blood
MH  - Creatine Kinase, MB Form/*blood
MH  - Electrocardiography/*methods
MH  - Female
MH  - Humans
MH  - Image Interpretation, Computer-Assisted/methods
MH  - Magnetic Resonance Imaging, Cine/*methods
MH  - Male
MH  - Myocarditis/*blood/*diagnosis
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Troponin/*blood
EDAT- 2014/10/16 06:00
MHDA- 2015/10/09 06:00
CRDT- 2014/10/16 06:00
PHST- 2014/02/04 00:00 [received]
PHST- 2014/10/01 00:00 [accepted]
PHST- 2014/10/16 06:00 [entrez]
PHST- 2014/10/16 06:00 [pubmed]
PHST- 2015/10/09 06:00 [medline]
AID - 10.1007/s00392-014-0770-7 [doi]
PST - ppublish
SO  - Clin Res Cardiol. 2015 Feb;104(2):154-63. doi: 10.1007/s00392-014-0770-7. Epub 
      2014 Oct 15.