Cardiovascular magnetic resonance assessment of human myocarditis - A comparison to histology and molecular pathology

被引:738
作者
Mahrholdt, H
Goedecke, C
Wagner, A
Meinhardt, G
Athanasiadis, A
Vogelsberg, H
Fritz, P
Klingel, K
Kandolf, R
Sechtem, U
机构
[1] Robert Bosch Med Ctr, Div Cardiol, D-70376 Stuttgart, Germany
[2] Robert Bosch Med Ctr, Dept Pathol, D-70376 Stuttgart, Germany
[3] Univ Tubingen, Dept Mol Pathol, D-72074 Tubingen, Germany
[4] Duke Cardiovasc MR Ctr, Durham, NC USA
关键词
myocarditis; biopsy; magnetic resonance imaging;
D O I
10.1161/01.CIR.0000118493.13323.81
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Myocarditis can occasionally lead to sudden death and may progress to dilated cardiomyopathy in up to 10% of patients. Because the initial onset is difficult to recognize clinically and the diagnostic tools available are unsatisfactory, new strategies to diagnose myocarditis are needed. Methods and Results - Cardiovascular MR imaging (CMR) was performed in 32 patients who were diagnosed with myocarditis by clinical criteria. To determine whether CMR visualizes areas of active myocarditis, endomyocardial biopsy was taken from the region of contrast enhancement and submitted to histopathologic analysis. Follow-up was performed 3 month later. Contrast enhancement was present in 28 patients ( 88%) and was usually seen with one or several foci in the myocardium. Foci were most frequently located in the lateral free wall. In the 21 patients in whom biopsy was obtained from the region of contrast enhancement, histopathologic analysis revealed active myocarditis in 19 patients ( parvovirus B19, n = 12; human herpes virus type 6 [HHV 6], n = 5). Conversely, in the remaining 11 patients, in whom biopsy could not be taken from the region of contrast enhancement, active myocarditis was found in one case only (HHV6). At follow-up, the area of contrast enhancement decreased from 9 +/- 11% to 3 +/- 4% of left ventricular mass as the left ventricular ejection fraction improved from 47 +/- 19% to 60 +/- 10%. Conclusions - Contrast enhancement is a frequent finding in the clinical setting of suspected myocarditis and is associated with active inflammation defined by histopathology. Myocarditis occurs predominantly in the lateral free wall. Contrast CMR is a valuable tool for the evaluation and monitoring of inflammatory heart disease.
引用
收藏
页码:1250 / 1258
页数:9
相关论文
共 34 条
[1]   Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis [J].
Angelini, A ;
Calzolari, V ;
Calabrese, F ;
Boffa, GM ;
Maddalena, F ;
Chioin, R ;
Thiene, G .
HEART, 2000, 84 (03) :245-250
[2]  
Aretz H T, 1987, Am J Cardiovasc Pathol, V1, P3
[3]   Fatal parvovirus B19-associated myocarditis clinically mimicking ischemic heart disease:: An endothelial cell-mediated disease [J].
Bültmann, BD ;
Klingel, K ;
Sotlar, K ;
Bock, CT ;
Baba, HA ;
Sauter, M ;
Kandolf, R .
HUMAN PATHOLOGY, 2003, 34 (01) :92-95
[4]   Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy [J].
Choudhury, L ;
Mahrholdt, H ;
Wagner, A ;
Choi, KM ;
Elliott, MD ;
Klocke, FJ ;
Bonow, RO ;
Judd, RM ;
Kim, RJ .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (12) :2156-2164
[5]  
COSTANZONORDIN MR, 1985, BRIT HEART J, V53, P25
[6]  
*DAT AN PROD DIV, 1999, S PLUS 2000 GUID STA
[7]   ACTIVE MYOCARDITIS IN THE SPECTRUM OF ACUTE DILATED CARDIOMYOPATHIES - CLINICAL-FEATURES, HISTOLOGIC CORRELATES, AND CLINICAL OUTCOME [J].
DEC, GW ;
PALACIOS, IF ;
FALLON, JT ;
ARETZ, HT ;
MILLS, J ;
LEE, DCS ;
JOHNSON, RA .
NEW ENGLAND JOURNAL OF MEDICINE, 1985, 312 (14) :885-890
[8]   Contrast media-enhanced magnetic resonance imaging visualizes myocardial changes in the course of viral myocarditis [J].
Friedrich, MG ;
Strohm, O ;
Schulz-Menger, J ;
Marciniak, H ;
Luft, FC ;
Dietz, R .
CIRCULATION, 1998, 97 (18) :1802-1809
[9]   THE NATURAL-HISTORY OF IDIOPATHIC DILATED CARDIOMYOPATHY [J].
FUSTER, V ;
GERSH, BJ ;
GIULIANI, ER ;
TAJIK, AJ ;
BRANDENBURG, RO ;
FRYE, RL .
AMERICAN JOURNAL OF CARDIOLOGY, 1981, 47 (03) :525-531
[10]   EVALUATION OF POSTMORTEM ENDOMYOCARDIAL BIOPSY SPECIMENS FROM 38 PATIENTS WITH LYMPHOCYTIC MYOCARDITIS - IMPLICATIONS FOR ROLE OF SAMPLING ERROR [J].
HAUCK, AJ ;
KEARNEY, DL ;
EDWARDS, WD .
MAYO CLINIC PROCEEDINGS, 1989, 64 (10) :1235-1245