0000005313 00000 n 101 In a recent series of 82 patients with myocarditis all of whom had biopsy-proven disease, CMR alone made the correct diagnosis in 80% (66 out of 82) cases. Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and for which the number of UK hospital admissions is rising. Diagnostic value of quantitative CMR in patients suspected of having myocarditis: a question of timing. Both myocarditis and ARVD can be studied by CMR, and a very specific set of criteria for myocarditis with a domi-nant role for CMR was recently described (11). Traditional CMR methods including T2-weighted imaging and late gadolinium enhancement . xref The aetiology is broad . 0000003353 00000 n doi: 10.1161/CIRCIMAGING.114.003073. The generally agreed CMR criteria of myocarditis include at least two (1) Regional or global myocardial signaling intensity increase in . 2015 Jan;8(1):109-110. doi: 10.1016/j.jcmg.2014.07.026. Includes new chapters on non-cardiac pathology, pacemaker safety, economics of CMR, and guidelines as well as new coverage of myocarditis and its diagnosis and assessment of prognosis by cardiovascular magnetic resonance, and the use of Besides, the recovery of myocardial tissue characterization was seldom considered in the . lH]@e)W(lc)a, M)spXTcf{2)mOMM -D. %%EOF 0000011513 00000 n Reply: Diagnostic value of quantitative CMR in patients suspected of having myocarditis: a question of timing. Modified Lake Louise criteria were used to make a diagnosis of myocarditis. 0000090922 00000 n Clinical Myocarditis: Clinical Presentation and Management . This book provides a comprehensive overview of the practical aspects of contrast echocardiography. trailer CMR was performed significantly earlier after symptom onset in the myocarditis group compared with COVID-19 patients (P = 0.013, Table 1). It appears that novel CMR mapping techniques provide high diagnostic accuracies for the diagnosis of acute myocarditis and add incremental value to the elements of the standard Lake Louise criteria for diagnosis. The diagnosis of myocarditis with use of clinical and imaging criteria is challenging due to its extremely heterogeneous manifestations ().Because the clinical presentation of myocarditis is frequently nonspecific, it may mimic more common causes of chest pain, dyspnea, and palpitations. Protocol included cine-SSFP, T2-weighted STIR, T2 mapping . Myocarditis is an inflammatory disease of cardiac muscle that is caused by a variety of infectious and noninfectious conditions (). In the context of a presumed low pretest probability in this cohort, MRI findings may not provide a definitive diagnosis of myocarditis. Diagnostic criteria for myocarditis . Predictive value of CMR criteria for LV functional improvement in patients with acute myocarditis Vermes E, Childs H, Faris P, Friedrich MG. Eur Heart J Cardiovasc Imaging. This site needs JavaScript to work properly. 0000013721 00000 n Therefore, the ability of conventional CMR criteria to discriminate between the health and disease in myocarditis is unsatisfactory, with a positive predictive value about 56-68% [65][66] [67 . Objectives: 1736 0 obj <>stream Clinical data and test results, including CMR findings, were abstracted from the medical record. JACC Cardiovasc Imaging. Kindermann et al. standard T2 sequences: global signal intensity ratio (myocardium/skeletal muscle . Circulation 2004;109: 1250-1258 . Evidence of myocardial edema was determined on the basis of abnormally high signal intensity on T2-weighted imaging or prolonged T2 relaxation . Luetkens JA, Homsi R, Sprinkart AM, Doerner J, Dabir D, Kuetting DL, Block W, Andri R, Stehning C, Fimmers R, Gieseke J, Thomas DK, Schild HH, Naehle CP. CMR in acute myocarditis. What is the diagnostic accuracy of various cardiovascular magnetic resonance (CMR) index tests for the diagnosis of acute myocarditis in adult patients? doi: 10.1097/MD.0000000000025050. In a small study, increased myocardial early gadolinium enhancement ratio at 4 weeks after clinical onset of the disease was associated with an impaired prognosis regarding functional recovery and symptoms after a 3-year follow-up . The use of CMR led to a 7.4-fold increase in the detection of myocarditis cases; only 0.31% of cases would have been detected without CMR. Objectives: This study evaluated the accuracy of T2, T1, and extracellular volume (ECV) quantification as novel quantitative tissue markers in comparison with standard "Lake-Louise" cardiac magnetic resonance (CMR) criteria to diagnose myocarditis. This meta-analysis reports that the accuracy of standard CMR techniques for the diagnosis of acute myocarditis is good, but can be further improved with the addition of novel parametric mapping techniques (T1 and T2 mapping). Methods and results: We studied 37 patients who referred for acute myocarditis during clinically acute myocarditis and after a 12-month follow-up. 2021 Oct 12;8:739892. doi: 10.3389/fcvm.2021.739892. Further, LGE is an independent predictor of mortality in acute myocarditis . In addition, many inherited cardiomyopathies (eg, Fabry disease and arrhythmogenic right ventricular [RV] cardiomyopathy) may present with features of acute or chronic myocarditis . myocarditis when biopsy and CMR cannot be performed or despite their negative results. hb```b````c`gf@ a;F&vM%*{/2 With CMR imaging, 31 of 37 findings reported as myocarditis met the modified Lake Louise Criteria (LLC), demonstrating elevated T2 and T1 or late gadolinium enhancement (LGE) in the same location. Predictive value of CMR criteria for LV functional improvement in patients with acute myocarditis Vermes E, Childs H, Faris P, Friedrich MG. Eur Heart J Cardiovasc Imaging. 0000086811 00000 n The AUC of T2 mapping was greater than the AUC of increased T2 ratio/signal and EGE, whereas ECV showed no superiority compared with other index tests. We present a 23-year-old male who is typical of a patient presenting with myocarditis post-COVID-19 mRNA-1273 Moderna vaccination (young males, onset several days after second dose of the mRNA vaccine, and excellent short term complete recovery). Jia Z, Wang L, Jia Y, Liu J, Zhao H, Huo L, Zheng B. J Appl Clin Med Phys. Methods Prospective case series from 1 st June 2021 until 31 st July 2021. Arrhythmogenic right ventricular dysplasia is an inherited heart muscle disorder that may cause abnormal electrical heart rhythms and weakening of the pumping action of the heart, resulting in sudden death. "The role of CMR in routine screening for athletes safe return to play should be explored further," the authors concluded. Cardiac parameters suggestive of myocarditis were no more common at 6 months after mild or asymptomatic COVID-19 than among people who never had the infection, a prospective case-control study . The areas under the curve (AUC) for each index test were for T1 mapping 0.95 (95% confidence interval [CI], 0.93-0.97), for T2 mapping 0.88 (95% CI, 0.85-0.91), for extracellular volume fraction (ECV) 0.81 (95% CI, 0.78-0.85), for increased T2 ratio/signal 0.80 (95% CI, 0.76-0.83), for late gadolinium enhancement (LGE) 0.87 (95% CI, 0.84-0.90), for early gadolinium enhancement (EGE) 0.78 (95% CI, 0.74-0.81), and for the Lake Louise criteria 0.81 (95% CI, 0.77-0.84). CMR is relatively safe and accessible, and has very high sensitivity, specificity and accuracy in diagnosing acute myocarditis.27 28 Applying the three proposed criteria by Friedrich et al of T2-weighted focal myocardial oedema, T1 . Initial laboratory findings showed markedly elevated high-sensitivity troponin T (1,200 ng/L), NT-pro BNP (4,400 pg/mL), and . Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Multiparametric cardiac magnetic resonance imaging in pediatric and adolescent patients with acute myocarditis. 8p`4fQh9oaxFar&A\*BnhT 0000068629 00000 n Detection of acute myocarditis using T1 and T2 mapping cardiovascular magnetic resonance: A systematic review and meta-analysis. 0000005963 00000 n Bohnen S, Radunski UK, Lund GK, Kandolf R, Stehning C, Schnackenburg B, Adam G, Blankenberg S, Muellerleile K. Circ Cardiovasc Imaging. Specifically for myocarditis, it is associated with acute and chronic heart failure and sudden cardiac death. Cardiovascular magnetic resonance criteria for myocarditis (Lake Louise Criteria) in the same patients: regional myocardial edema (top left), hyperemia in images acquired early after contrast injection (top right), and inflammatory necrosis in images acquired late (>10 minutes) after contrast injection (bottom). CMR findings consistent with myocarditis were classified based on updated 2018 Lake Louise criteria (LLC). Myocarditis can present as different clinical syndromes that range from mild chest pain with transient ecg changes to heart failure and . Cardiac MRI protocol allowed for . METHODS PATIENTS AND CONTROLS.The study population included 125 subjects: 104 consecutive patients with myocarditis who underwent clinically-indicated CMR, and a control group of 21 healthy individuals. This book is composed of the main topics on pathophysiology, general forms and specific types of cardiomyopathies and it also introduces new research in the field. Oedema was the only independent predictor for improvement in systolic function and a decrease of end-systolic volume. Eosinophilic Myocarditis. Accessibility Nevertheless, this statement discusses clinical and laboratory features that 0000005056 00000 n The Lake Louise Criteria (LLC) are the conventional guidelines used to help establish the diagnosis of myocarditis by CMR and focus on fulfilling 2 out of 3 positive criteria for evidence of hyperemia, edema, and myocardial necrosis/fibrosis . This book is an up-to-date, comprehensive, clinically oriented guide to the diagnosis and treatment of patients with myocarditis. CMR was able to confirm the diagnosis of acute myocarditis in the majority of patients with a clinical suspicion of acute myocarditis based on the clinical criteria. This book provides readers with a thorough overview of many advances in cardiac imaging. CMR myocardial edema and/or scarring were observed in all of the SARS-CoV-2-related myocarditis cases for which CMR results were reported. Kindermann et al. 0000086670 00000 n The protocol included . 2015 Jun;8(6):e003073. Mapping myocarditis: still searching for the north star. proportion of myocarditis and inammatory cardio-myopathy patients, particularly those with a DCM phenotype.23 24 35-78 Autoimmune diseases in humans full at least two of the major criteria pro-posed by Witebsky and Rose.79 80 In keeping with the ndings in other conditions, in myocarditis and in autoimmune DCM there may be familial .
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